I am very concerned with if researchers are using values of Troponin T as an indicator of severity of septic patients. Reflecting on my experiences in intensive care unit, patients with septic shock supposedly showed elevated Troponin T whether they had apparent cardiac damages or not (regardless of normal findings of UCG and EKG). I hinted the article published in 2013 by Vasile VC et al entitled "Elevated cardiac troponin T levels in critically ill patients with sepsis.(Am J Med)". Could you give me any suggestion about the correlation of values of Trponin T and severity of sepsis?
In 2002, we observed that troponin was a prognostic factor in our 136 septic ICU pts (OR 2.5 in case of tropo > 3ng/ml), but in comparison with the weight of SAPSII, according to the area under the ROC curve, we concluded that “troponin is not an independent predictor of mortality. Unfortunately being retired I have no more access to SPSS to answer your question about the correlation between SAPS II and troponin elevation (see the full text in my contribution part). In comparison with Vasile Vc et al study, we used a higher cutoff level of tropo.
Bessieres et al (Intensive Care Med, 2013) in their meta-analysis of 1217 pts concluded that “troponin identifies septic pts at higher risk of death”.
Sehyn et al, in a new meta-analysis which enrolled 1857 pts demonstrated that troponin elevation in pts with sepsis confers poorer prognosis and is a predictor of mortality (Hear and Lung 2015).
Thus, using meta-analysis approach, elevated troponin is per se a prognostic factor during sepsis,
but the weight of a troponin elevation on the outcome in comparison with SAPS II is not yet established with a large multicenter study using Logistic regression analysis or a propensity score. In absence of such series, the relation between the level of Tropo and severity should be an interesting purpose.
Yes, we have been using the troponin test since the 00th. That is not an independent predictor of mortality, but is one of ruther useful tools for the sepsis severity to be proved for insurance companies. I must to say that a severe sepsis can be diagnosted clinically, usually from an experienced clinician's first sight, and any prognostic scales ever suggested are far from it.
No we don't. I think it depends on the type of your ICU. As my ICU is not cardiovascular, I only use troponin for the screening for the patient whose clinical course is suspected to be related to cardiovascular events. Positive troponin test was limited. Less than 1% in the population.
I agree dr brivet we did the same and had the same conclusion it would be interresting to intergrate that parameter in severity score and more the absolute value May be thé évolution of 48h
Yes, I think that troponin would be a good marker for diagnosing and predicting the prognosis of neonatal sepsis. Interestingly, now we are conducting a study related to this topic.
Ours is a cardiac ICU for neonates and children who have congenital cardiac defects (which have been surgically repaired). We have not looked at Trop levels as it would be necessarily elevated in babies post CPB. There is infection as well...so it may not differentiate one from the other.
Troponin might be an indicatior for septic cardiopathy as one puzzlestone in septic multiorganic failure.
Should be considered to study for and should be proposed to e.g. Sepsis Surveillance Compain!
No we don't use it as a marker for severity of sepsis & prognostication, as we look at APACHE II score, SAPS II score & the SOFA score for severity. If we suspect myocardial depression due to sepsis then we do an ECHO cardiography and may do a Trop I and/or CPK (MB) to look at the severity of the myocardial involvement.
I appreciate all of you for helping me with explicit answers. Initially, I was mystified with the fact that, in many cases of septic shock, elevated Troponin levels can be observed regardless of their underlying cardiac conditions. But I now think that it is plausible that cardiac function may be damaged in the process of multiorganic failure accompanied by septic shock. If I have a chance, I would examine whether there is any correlations with the levels of Troponin and damage of organs. Thanks again for giving me helpful answers!
Hi all. Nice question. This is an interesting issue. Think it is easier to understand why does troponin rise in septic shock after reading papers like this: http://circ.ahajournals.org/content/104/25/3137.full.pdf+html
Best.
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