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Original Article

Myocardial Injury in Patients With Sepsis and Its Association With Long-Term Outcome

Jos F. Frencken, Dirk W. Donker, Cristian Spitoni, Marlies E. Koster-Brouwer, Ivo W. Soliman, David S.Y. Ong, Janneke Horn, Tom van der Poll, Wilton A. van Klei, Marc J.M. Bonten, Olaf L. Cremer
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https://doi.org/10.1161/CIRCOUTCOMES.117.004040
Circulation: Cardiovascular Quality and Outcomes. 2018;11:e004040
Originally published January 29, 2018
Jos F. Frencken
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Dirk W. Donker
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Cristian Spitoni
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Marlies E. Koster-Brouwer
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Ivo W. Soliman
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David S.Y. Ong
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Janneke Horn
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Tom van der Poll
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Wilton A. van Klei
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Marc J.M. Bonten
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Olaf L. Cremer
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Abstract

Background: Sepsis is frequently complicated by the release of cardiac troponin, but the clinical significance of this myocardial injury remains unclear. We studied the associations between troponin release during sepsis and 1-year outcomes.

Methods and Results: We enrolled consecutive patients with sepsis in 2 Dutch intensive care units between 2011 and 2013. Subjects with a clinically apparent cause of troponin release were excluded. High-sensitivity cardiac troponin I (hs-cTnI) concentration in plasma was measured daily during the first 4 intensive care unit days, and multivariable Cox regression analysis was used to model its association with 1-year mortality while adjusting for confounding. In addition, we studied cardiovascular morbidity occurring during the first year after hospital discharge. Among 1258 patients presenting with sepsis, 1124 (89%) were eligible for study inclusion. Hs-cTnI concentrations were elevated in 673 (60%) subjects on day 1, and 755 (67%) ever had elevated levels in the first 4 days. Cox regression analysis revealed that high hs-cTnI concentrations were associated with increased death rates during the first 14 days (adjusted hazard ratio, 1.72; 95% confidence interval, 1.14–2.59 and hazard ratio, 1.70; 95% confidence interval, 1.10–2.62 for hs-cTnI concentrations of 100–500 and >500 ng/L, respectively) but not thereafter. Furthermore, elevated hs-cTnI levels were associated with the development of cardiovascular disease among 200 hospital survivors who were analyzed for this end point (adjusted subdistribution hazard ratio, 1.25; 95% confidence interval, 1.04–1.50).

Conclusions: Myocardial injury occurs in the majority of patients with sepsis and is independently associated with early—but not late—mortality, as well as postdischarge cardiovascular morbidity.

  • infection
  • intensive care units
  • mortality
  • sepsis
  • troponin
  • Received June 23, 2017.
  • Accepted November 30, 2017.
  • © 2018 American Heart Association, Inc.
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Circulation: Cardiovascular Quality and Outcomes
February 2018, Volume 11, Issue 2
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    Myocardial Injury in Patients With Sepsis and Its Association With Long-Term Outcome
    Jos F. Frencken, Dirk W. Donker, Cristian Spitoni, Marlies E. Koster-Brouwer, Ivo W. Soliman, David S.Y. Ong, Janneke Horn, Tom van der Poll, Wilton A. van Klei, Marc J.M. Bonten and Olaf L. Cremer
    Circulation: Cardiovascular Quality and Outcomes. 2018;11:e004040, originally published January 29, 2018
    https://doi.org/10.1161/CIRCOUTCOMES.117.004040

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    Myocardial Injury in Patients With Sepsis and Its Association With Long-Term Outcome
    Jos F. Frencken, Dirk W. Donker, Cristian Spitoni, Marlies E. Koster-Brouwer, Ivo W. Soliman, David S.Y. Ong, Janneke Horn, Tom van der Poll, Wilton A. van Klei, Marc J.M. Bonten and Olaf L. Cremer
    Circulation: Cardiovascular Quality and Outcomes. 2018;11:e004040, originally published January 29, 2018
    https://doi.org/10.1161/CIRCOUTCOMES.117.004040
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