Prognostic value of troponins in sepsis: a meta-analysis

Abstract

Rationale: The role of biomarkers such as troponin in risk stratification of sepsis is still debated. The aim of this meta-analysis is to assess the relation between troponin elevation in sepsis and mortality.

Methods: All observational studies from Embase, Medline and those manually searched up to September 2010 were included. Studies identified were those which reported on patients with a diagnosis of sepsis and if a 2 × 2 table could be constructed based on troponins and death. We pooled the relative risk (RR) and odds-ratio (OR) using the inverse variance method in studies that conducted univariate and multivariable (adjusted) analysis.

Main results: Thirteen studies encompassing 1,227 patients were included. The prevalence of elevated troponin was 61 % ([95 %] CI 58-64 %). Elevated troponin was significantly associated with all-cause mortality (RR 1.91; CI 1.63-2.24), with homogeneity across studies. In adjusted analysis (four studies comprising 791 patients) according to prognostic scores, elevated troponin was associated with an increased risk of death (OR 1.92; CI 1.35-2.74). The area under the ROC curve was 0.68 (CI 0.63-0.71). Pooled sensitivity and specificity were 77 % (CI 61-88) and 47 % (CI 30-64) with heterogeneity across studies. It corresponded to positive and negative likelihood ratios of 1.50 (95 % CI: 1.20-1.90) and 0.49 (CI 0.38-0.64), respectively.

Conclusions: Elevated troponin identifies a subset of patients with sepsis at higher risk of death. Further studies are needed to define the precise role of troponins and their optimal cut-offs.