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Elevated serum levels of cardiac-specific troponin I (cTnI) are claimed to be associated with the degree of sepsis-related cardiac dysfunction and with the disease outcome in critically ill. We tested this association in a specific group of ICU patients with post-traumatic sepsis.
A prospective observational study was conducted in an ICU of a level I-equivalent trauma center between September 2008 and August 2009. No exclusion criteria were adopted. Serum cTnI concentrations were collected at peak sepsis-related cardiovascular dysfunction (defined by the highest pressure adjusted heart rate (PAR) in MODS score and by the dose of the inotrope). Data were gathered on demographics, severity of inflammatory response (SIRS criteria) and organ dysfunction (MODS score), presence of superimposed acute coronary events, other potential reasons for cTnI elevation and the disease outcome. Intergroup comparisons were made with Student's t test/nonparametric alternatives. The prognostic utility of cTnI was examined by the construction of ROC curves and its levels were categorized on the basis of the defined cut-off value. Probable associations between these categories and the organ dysfunction severity, as well as the outcome, were examined with Fisher's exact test.
A total of 92 polytrauma patients were enrolled. The confidence intervals of PAR, MODS and SIRS were 21.26 ± 2.72, 6.99 ± 2.94 and 3.75 ± 1.10, respectively. Blunt cardiac injury had been diagnosed in 20 patients (21.7%) on admission. Three patients (3.3%) developed acute coronary events during their ICU stay and 12 patients (13.2%) had other potential reasons for cTnI elevation. Significantly higher cTnI concentrations were found in the critically ill with myocardial contusion and with acute coronary events. However, the presence of blunt cardiac injury had no measurable outcome effect. Troponin I levels were significantly higher in nonsurvivors (P = 0.00) and very good prognostic performance of cTnI was found (AUROC = 0.82; cut-off value = 0.05 ng/ml). The subsequent comparison between its categorized values and those of PAR and MODS showed strong positive association. Elevated cTnI concentrations (>0.05 ng/ml) significantly increased the risk of death (RR = 5.58; 95% CI = 1.67 to 20.79; P = 0.002).
In a group of patients with post-traumatic sepsis elevated serum cTnI levels proved to be a good marker of severe organ (including cardiovascular) dysfunction. They also showed reasonable prognostic value regarding the disease outcome.