Cardiac Troponin I as a Prognostic Indicator of Mortality in Patients With Sepsis and Organ Dysfunction

TL;DR

This study shows that high levels of cardiac troponin I in sepsis patients are strongly linked to higher mortality and can help predict outcomes.

Contribution

The study identifies a specific troponin I threshold (>0.04 ng/mL) as a highly accurate predictor of mortality in sepsis patients with organ dysfunction.

Findings

69% of sepsis patients had elevated troponin I levels, which were strongly associated with increased 28-day mortality.

Troponin I showed high prognostic accuracy with an AUC of 0.986 in predicting mortality.

Elevated troponin I was linked to longer ICU stays and higher SOFA scores.

Abstract

Introduction and aim

Sepsis is a complex, life-threatening condition characterized by systemic inflammation and multiorgan dysfunction. Elevated troponin levels (cTnI) have been associated with poor outcomes in sepsis; however, their role as a prognostic biomarker requires further investigation. This study aimed to (1) determine the association between elevated cardiac troponin I (>0.04 ng/mL) and 28-day mortality in patients with sepsis and organ dysfunction, and (2) evaluate the prognostic accuracy of troponin I for mortality prediction in this population.

Methods

We conducted a prospective cohort study involving 200 sepsis patients, measuring troponin levels at admission time and clinical and biochemical parameters, such as Sequential Organ Failure Assessment (SOFA) scores, D-dimer, and lactate. Data on organ dysfunction, coagulation abnormalities, and patient outcomes (mortality, length of ICU stay) were collected and analyzed.

Results

Troponin I levels were elevated in 69% of patients and were significantly associated with increased mortality (115 {83.4%} vs. 10 {16.2%}; p<0.001), longer ICU duration, and higher SOFA scores. Multivariate analysis revealed that elevated creatinine, low hemoglobin, increased CRP and alanine transaminase (ALT), neutrophilia, and reduced oxygen saturation were independent predictors of 28-day mortality. Troponin I showed high prognostic accuracy for mortality, and a cut-off value of >0.04 ng/mL demonstrated remarkable accuracy, achieving an AUC of 0.986 in receiver operating characteristic (ROC) analysis.

Conclusion

Troponin I serves as a readily accessible and prognostically significant biomarker that improves early risk assessment in patients experiencing sepsis with organ dysfunction.

Figures