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Prognostic Value of High-sensitivity Troponin I in Patients with Septic Shock: A Prospective Observational Study
Ali Jendoubi1, Salma Jerbi1, Elaa Maamar2,3
1Department of Anaesthesia and Intensive Care, Charles Nicolle Hospital of Tunis, Tunisia.
Insights
High-sensitivity cardiac troponin I (hs-cTnI) levels at 72 hours are a significant predictor of 28-day mortality in septic shock patients. This finding aids in assessing prognosis for critically ill individuals with septic shock.
Area of Science:
- Critical Care Medicine
- Cardiology
- Biomarkers
Background:
- Myocardial dysfunction is a key factor in septic shock pathophysiology.
- The utility of troponin as a myocardial injury marker in septic shock remains under investigation.
Purpose of the Study:
- To evaluate the prognostic capability of high-sensitivity cardiac troponin I (hs-cTnI) assay.
- To predict 28-day mortality in patients diagnosed with septic shock.
Main Methods:
- Prospective observational study of 75 septic shock patients in an ICU.
- hs-cTnI levels measured at baseline and 12, 24, 48, and 72 hours post-admission.
- Receiver operating characteristic (ROC) analysis used to determine optimal hs-cTnI cut-off for mortality prediction.
Main Results:
- 28-day mortality rate was 54.6%.
- Elevated hs-cTnI was prevalent in 47% of patients.
- hs-cTnI levels were significantly higher in non-survivors compared to survivors at all measured time points; hs-cTnI at 72 hours was independently associated with 28-day mortality.
Conclusions:
- Elevated hs-cTnI at 72 hours is a significant independent predictor of 28-day mortality in septic shock.
- hs-cTnI serves as a valuable prognostic biomarker in septic shock management.
Background:
Myocardial dysfunction is one of the mechanisms involved in the pathophysiology of septic shock. The role of troponin as a surrogate of myocardial injury in septic shock is still debated. The aim of this study was to assess the prognostic value of high-sensitivity cardiac troponin I (hs-cTnI) assay in predicting 28-day mortality in patients with septic shock.
Materials And Methods:
Prospective study including 75 patients with septic shock admitted to a medico-surgical ICU from January to December 2017. Patients under the age of 18 years, known pregnancy and patients in post-cardiac arrest were excluded. Clinical and demographic data including age, gender, comorbidities, SAPS II and SOFA scores were collected. Hs-cTnI was measured soon after admission and 12, 24, 48 and 72 after. Receiver operating characteristic (ROC) analysis was performed to identify the most useful troponin I cut-off level for the prediction of 28-day mortality. A p <0.05 was considered significant.
Results:
Seventy-five (M/F = 53/22) patients with septic shock were included in the study. The median SOFA and SAPS II scores were 10 and 42, respectively. The median duration of mechanical ventilation was 8 days and the median length of ICU stay was 11 days. The 28-day mortality was 54.6%. We found a high prevalence (47%) of elevated hs-cTnI in patients with septic shock. Median hs-cTnI on admission in the whole group was 36 ng/L. The 28-day mortality was found to be related to age (p <0.001), SAPS II score (p = 0.001), mean arterial pressure (p = 0.038), lactate (p <0.001) and glomerular filtration rate (p <0.001).Hs-cTnI levels were significantly higher in non-survival group than survival one at all time points: H12 (p = 0.006), H24 (p = 0.003), H48 (p = 0.005) and H72 (p=0.001). In multivariate analysis, hs-cTnI at H72 was independently associated with 28-day mortality.
Conclusion:
Hs-cTnI elevation at 72 hours was associated with 28-day mortality in septic shock patients.
How To Cite This Article:
Jendoubi A, Jerbi S, Maamar E, Abbess A, Samoud Z, Kanzari L, et al. Prognostic Value of High-Sensitivity Troponin I in Patients with Septic Shock: A Prospective Observational Study. Indian J Crit Care Med 2019;23(7):320-325.
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