Impact of Elevated Troponin Level at the Time of Sepsis Recognition on the Clinical Outcomes: A Propensity Score-Matched Cohort Study

Abstract

Background: Sepsis-induced cardiac dysfunction, known as septic cardiomyopathy, is a common complication associated with increased mortality. Cardiac troponins serve as markers for myocardial injury and are frequently elevated in patients with sepsis. However, the role of troponin elevation at sepsis recognition in risk stratification remains controversial.

Methods and results: This nationwide multicenter prospective cohort study analyzed 2141 adult patients with sepsis without prior cardiovascular disease from the Korean Sepsis Alliance registry. These patients were classified as having either elevated troponin levels or troponin levels in the normal range at the time of sepsis recognition, according to the reference ranges specific to each participating institution. The primary outcome was hospital mortality, and propensity score matching was used to control for confounding factors. In the propensity score-matched cohort (523 pairs), there were no significant differences in hospital mortality (35.2% versus 32.7%, odds ratio [OR], 1.12 [95% CI, 0.86-1.44], P=0.396), hospital length of stay (13.0 versus 15.0 days, OR, 1.00 [95% CI, 0.99-1.00], P=0.128), intensive care unit mortality (24.7% versus 25.0%, OR, 0.98 [95% CI, 0.74-1.30], P=0.886), or intensive care unit length of stay between the elevated troponin and control groups. However, landmark analysis revealed that the elevated troponin group had a lower survival probability after 1 week (log-rank P=0.033) and significantly higher kidney Sequential Organ Failure Assessment scores from intensive care unit admission to day 7 (P=0.003).

Conclusions: Troponin elevation at sepsis recognition was not significantly associated with increased hospital mortality or worse clinical outcomes in patients with sepsis.

Keywords: mortality; sepsis; shock; troponin.

Figure 1. Scheme of patient selection and group distribution.

ED indicates emergency department; and ICU, intensive care unit.

Figure 2. Kaplan–Meier survival curve for sepsis patients stratified by cardiac troponin or not.

Blue line=elevated group, red line=control group.

Figure 3. Sequential Organ Failure Assessment score changes from intensive care unit admission to day 7.

A, Total SOFA, P=0.500, (B) Respiratory SOFA, P=0.510, (C) Coagulation SOFA, P=0.981, (D) Liver SOFA, P=0.760, (E) Cardiovascular SOFA, P=0.750, (F) Central nervous system SOFA, P=0.354, (G) Renal SOFA, P=0.032. Blue line=elevated group, red line=control group. CNS indicates central nervous system; CV, cardiovascular; SMD, standardized mean difference; and SOFA, Sequential Organ Failure Assessment.