Chest
Volume 113, Issue 4, April 1998, Pages 1055-1063
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Clinical Investigations in Critical Care
Serum Cardiac Troponin T as a Prognostic Marker in Early Sepsis

https://doi.org/10.1378/chest.113.4.1055Get rights and content

Study objective

Sepsis is the leading cause of death in the noncardiologic ICU. Maldistributed nutritive blood flow and altered convective and diffusive oxygen transport during sepsis can lead to organ dysfunction and multiple organ failure. One of the causes of myocardial dysfunction is thought to be myocardial ischemia in sepsis; however, conventional biochemical parameters to detect myocardial ischemia lack sensitivity and specificity. Serum cardiac troponin T (S-TnT) was reported to have higher sensitivity and specificity in diagnosing minor myocardial injury. The aim of this study was to investigate if and how often S-TnT is pathologically elevated in patients with sepsis and to evaluate whether S-TnT might be a prognostic marker in early sepsis.

Design

Prospective study.

Setting

Surgical ICU.

Patients

Twenty-six patients with sepsis were included in this study within 24 h of the onset of sepsis. The patients were allocated a priori to a high S-TnT group (S-TnT≥0.2 μg/L) and a low S-TnT group (S-TnT<0.2 μg/L).

Measurement

Blood samples for the determination of S-TnT and conventional myocardial ischemia markers as well as for adhesion molecules were drawn. Hemodynamic measurements were performed every 4 h during the first 24 h and then once per day over 7 days. S-TnT was determined by enzyme-linked immunosorbent sandwich assay.

Results

Eighteen patients had pathologically high S-TnT values. High S-TnT values were associated with an increased mortality rate (15/18 in the high S-TnT group vs 3/8 in the low S-TnT group; p=0.02). Significant differences between the two groups were found in the norepinephrine dosages at maximum values of S-TnT. Soluble intercellular adhesion molecule-1 was significantly elevated in the high S-TnT group.

Conclusions

As high S-TnT values were associated with an increased mortality rate, it seems reasonable to further evaluate S-TnT as a prognostic marker of myocardial ischemia in patients with sepsis under different therapeutic regimens.

Section snippets

Subjects

Twenty-six patients with sepsis in the ICU were included in this institutionally approved study. It was carried out from 1993 to 1995, according to the criteria of sepsis of the American College of Chest Physicians Consensus Conference,16 having obtained the relatives' informed consent. APACHE (acute physiology and chronic health evaluation) III17 and MOF18 scores were recorded.

Patients were assigned a priori to two groups: (1) with pathologically elevated S-TnT levels (≥0.2 μg/L), and (2) with

RESULTS

Eighteen patients had pathologically elevated S-TnT values, and 8 patients normal S-TnT values. Basic patient characteristics and causes of sepsis (Table 1, Table 2) did not differ significantly between both of these groups. All patients were operated on prior to sepsis. The period between surgery and the onset of sepsis was a median of 5 days (range, 0 to 20 days) for the high S-TnT group and 2 days (range, 1 to 6 days; p=0.334) for the low S-TnT group. Elevated levels of S-TnT were associated

DISCUSSION

The most important result of this study was that elevated S-TnT values were found in patients with sepsis (69%) and this was associated with a higher mortality rate. In 16 of 26 patients, a rise in S-TnT level indicated a poor prognostic outcome. Due to the higher frequency of nonsurvivors in the high S-TnT group, the length of the ICU stay did not differ between groups.

Inadequate myocardial performance is reported to be an important factor contributing to the high mortality in patients with

ACKNOWLEDGMENT

We would like to extend our thanks to A. Schoenknecht (Laboratory of the Department of Clinical Medicine) for her help with the determination of S-TnT and CK-MB and M. Kaynar (Laboratory of the Department of Anesthesiology and Operative Intensive Care Medicine) for her help with the determination of the adhesion molecules.

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    Materially supported in part by Boehringer Mannheim Inc, Germany.

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