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Comparison of Troponin I levels versus myocardial dysfunction on prognosis in sepsis

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Abstract

In the context of sepsis, we tested the relationship between echocardiographic findings and Troponin, and their impact on prognosis. In this prospective study, we enrolled 325 septic patients (41% with shock), not mechanically ventilated, between October, 2012 and June, 2019 among those admitted to our High-Dependency Unit. By echocardiography within 24 h from the admission, sepsis-induced myocardial dysfunction (SIMD) was defined as left ventricular (LV) systolic dysfunction (speckle-tracking-based global longitudinal peak systolic strain, GLS, >  – 14%) and/or right ventricular (RV) systolic dysfunction (Tricuspid Annular Plane Systolic Excursion, TAPSE < 16 mm). Troponin I levels were measured upon admission (T0) and after 24 h (T1); it was considered normal if > 0.1 ng/mL. Mortality was assessed at day-7 and day-28 end-points. One-hundred and forty-two patients had normal Troponin level at T0 and T1 (G1), 69 had abnormal levels at T0 or T1 (G2) and 114 showed abnormal Troponin levels at both T0 and T1 (G3). Compared to G1, patients in G3 had worse LV and RV systolic function (GLS  – 11.6 ± 3.4% vs  – 14.0 ± 3.5%, p < 0.001; TAPSE 18 ± 0.5 vs 19 ± 0.5 mm, p = 0.047) and greater day-28 (34% vs 20%, p = 0.015) mortality. In a Cox survival analysis including age, Troponin and SOFA score, mortality was predicted by the presence of SIMD (RR 3.24, 95% CI 1.72–6.11, p < 0.001) with no contribution of abnormal Troponin level. While abnormal Troponin levels were associated with SIMD diagnosed by echocardiography, only the presence of SIMD predicted the short- and medium-term mortality rate, without an independent contribution of increased Troponin levels.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Firenze, Italy

    Francesca Innocenti, Valerio Teodoro Stefanone, Federico D’Argenzio, Marco Cigana, Michele Montuori, Elisa Capretti, Anna De Paris, Stefano Calcagno, Irene Tassinari & Riccardo Pini

  2. Transplant Cardiosurgery Unit, Department of Cardiac Surgery and Transplant, Ospedale Dei Colli Monaldi-Cotugno-CTO, Naples, Italy

    Vittorio Palmieri

Authors
  1. Francesca Innocenti
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  2. Vittorio Palmieri
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  3. Valerio Teodoro Stefanone
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  4. Federico D’Argenzio
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  5. Marco Cigana
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  6. Michele Montuori
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  7. Elisa Capretti
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  8. Anna De Paris
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  9. Stefano Calcagno
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  11. Riccardo Pini
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Contributions

F. Innocenti and V. Palmieri gave substantial contributions to the conception and design of the work, drafted and revised the manuscript. F. D’Argenzio, M Cigana, M. Montuori, A. De Paris, E. Capretti and S. Calcagno gave substantial contributions in the acquisition, analysis, or interpretation of data for the work. F. Innocenti, I. Tassinari and V.T. Stefanone drafted the manuscript; V. Palmieri revised it critically for important intellectual content. R. Pini gave the final approval of the version to be published.

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Correspondence to Francesca Innocenti.

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The authors declare they have no conflict of interest.

Human and animal rights

The study protocol was approved by the “Toscana – Area Vasta—Centro” inter-institutional ethic committee (registration number OSS.13.031) and was conducted in accordance with the Helsinki Declaration of 1964 (revised 2008).

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All the patients gave informed consent to enter the study.

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Innocenti, F., Palmieri, V., Stefanone, V.T. et al. Comparison of Troponin I levels versus myocardial dysfunction on prognosis in sepsis. Intern Emerg Med 17, 223–231 (2022). https://doi.org/10.1007/s11739-021-02701-3

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