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Early high-sensitivity troponin elevation and short-term mortality in sepsis: a systematic review with meta-analysis
(Springer Science and Business Media LLC, 2025-02-14)
Abraham I. J. Gajardo
;
Santiago Ferrière-Steinert
;
Joaquín Valenzuela Jiménez
;
Sebastián Heskia Araya
;
Thomas Kouyoumdjian Carvajal
Abstract Background Serum cardiac troponin (cTn) elevation is a well-established phenomenon in sepsis. However, the clinical signifcance of this phenomenon with high-sensitivity (hs) assays and the current sepsis defnition needs to be settled. Research Question What is the association between early serum cTn levels measured by hs-assays and the risk of short-term mortality in septic patients? Study Design and Methods We conducted a systematic review using a comprehensive PubMed, Scopus, and Embase search. Studies were eligible if they reported association data on early hs-cTn and mortality in an adult sample with sepsis that met the Sepsis-3 defnition. For the synthesis of the efect of hs-cTn on mortality, we applied random efect models on the pooled unadjusted and adjusted odds ratio (OR and aOR, respectively) of elevated vs. normal hs-cTn serum values, and on the crude standardized mean diference (SMD) of hs-cTn between survivors and non-survivors. Results In total, 6242 patients from 17 studies were included, with short-term mortality rates ranging from 16.9% to 53.8%. Using a crude analysis, non-survivor patients showed higher hs-cTn than survivors (SMD of 0.87, 95%CI: 0.41–1.33). Elevated hs-cTn was associated with increased mortality (OR=1.78, 95% CI: 1.41–2.25). However, this prognostic efect was absent in studies that adjusted for diferent confounders (aOR=1.06, 95% CI: 0.99–1.14). Discussion and Conclusions Non-survivors of sepsis exhibited signifcantly elevated hs-cTn levels. While elevated hs-cTn levels are associated with an increased risk of mortality, they are not independently associated with this outcome in sepsis
Scopus© Citations 3 1
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Editorial: Immune response to gram-negative bacteria in the lungs
(2024)
Agnes Jara-Collao
;
POLI HARLOWE, MARIA CECILIA BERTA
;
William Bain
;
Hernán F. Peñaloza
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Early high-sensitivity troponin elevation in predicting short-term mortality in sepsis: A protocol for a systematic review with meta-analysis
(2024)
Santiago Ferrière-Steinert
;
Joaquín Valenzuela Jiménez
;
Sebastián Heskia Araya
;
Thomas Kouyoumdjian
;
José Ramos-Rojas
<jats:sec id="sec001"> <jats:title>Background</jats:title> <jats:p>Sepsis is a common admission diagnosis in the intensive care unit (ICU). The Sepsis-3 consensus associates sepsis diagnosis with acute organ dysfunction. In these patients troponin elevation is a well-established phenomenon, but its clinical significance is not settled, as no systematic review has addressed the prognostic significance of the increasingly prevalent high-sensitivity troponin assays in acute organ dysfunction setting.</jats:p> <jats:p>This study aims to clarify the association between early serum troponin levels in high-sensitivity assays with short-term mortality risk in septic patients with acute organ dysfunction.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Methods</jats:title> <jats:p>We will systematically search PubMed, Scopus and Embase for original articles; additionally, a manual search will be carried out through relevant literature. Generally, studies will be deemed eligible for inclusion if they evaluate the association between high-sensitivity troponin in the first 24 hours of admission and ICU, 30-days, or In-hospital mortality; in patients with septic shock or sepsis related to acute organ dysfunction. Two reviewers will independently select studies and extract the data. A meta-analysis for mortality outcome will be performed for comparative data regarding two effect measures: Odd ratios and Standardized Mean differences.</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Discussion</jats:title> <jats:p>This study will provide further evidence about the role of high-sensitivity troponin assays in predicting mortality in septic patients; potentially helping to guide further research and yielding valuable information for patient assessment.</jats:p> <jats:p>Conclusion about the certainty of evidence will be presented in a ´Summary of findings´ table.</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Trial registration</jats:title> <jats:p>PROSPERO registration:</jats:p> <jats:p>(<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024468883" xlink:type="simple">CRD42024468883</jats:ext-link>).</jats:p> </jats:sec>
8Scopus© Citations 3
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Clasificación PIRO en sepsis grave y shock séptico pediátrico: Nuevo modelo de estratificación y su utilidad en pronóstico
(2010)
Daniela Arriagada S
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Franco Díaz R
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Alejandro Donoso F
;
Pablo Cruces R
1
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Shock séptico en pediatría I: Enfoque actual en el diagnóstico y tratamiento
(2013)
DONOSO F, ALEJANDRO
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ARRIAGADA S, DANIELA
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CRUCES R, PABLO
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DÍAZ R, FRANCO
Scopus© Citations 2 3
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Sífilis congénita: presentación como shock séptico después del período neonatal
(2012)
Daniela Arriagada
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Alejandro Donoso
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Pablo Cruces
;
Franco Díaz
6Scopus© Citations 6
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Priorities and Progress in Gram-positive Bacterial Infection Research by the Antibacterial Resistance Leadership Group: A Narrative Review
(2023)
Sarah B Doernberg
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Cesar A Arias
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Deena R Altman
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Ahmed Babiker
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Helen W Boucher
<jats:title>Abstract</jats:title><jats:p>The Antibacterial Resistance Leadership Group (ARLG) has prioritized infections caused by gram-positive bacteria as one of its core areas of emphasis. The ARLG Gram-positive Committee has focused on studies responding to 3 main identified research priorities: (1) investigation of strategies or therapies for infections predominantly caused by gram-positive bacteria, (2) evaluation of the efficacy of novel agents for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci, and (3) optimization of dosing and duration of antimicrobial agents for gram-positive infections. Herein, we summarize ARLG accomplishments in gram-positive bacterial infection research, including studies aiming to (1) inform optimal vancomycin dosing, (2) determine the role of dalbavancin in MRSA bloodstream infection, (3) characterize enterococcal bloodstream infections, (4) demonstrate the benefits of short-course therapy for pediatric community-acquired pneumonia, (5) develop quality of life measures for use in clinical trials, and (6) advance understanding of the microbiome. Future studies will incorporate innovative methodologies with a focus on interventional clinical trials that have the potential to change clinical practice for difficult-to-treat infections, such as MRSA bloodstream infections.</jats:p>
8Scopus© Citations 7
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Consideraciones geográficas en la interpretación de los resultados de revisiones sistemáticas y meta-análisis: fluidos en sepsis pediátrica
(2019)
Franco Díaz
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Sebastian Gonzalez-Dambrauskas
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Jan Hau Lee
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Pablo Cruces
1Scopus© Citations 1
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¿Debemos utilizar las directrices de la Campaña Sobreviviendo a la Sepsis en niños con sepsis temprana? Enfoque en infusión inicial rápida de fluidos
(2019)
Franco Díaz
;
Pablo Cruces
29Scopus© Citations 2
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Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate
(2021)
LOPEZ HERNANDEZ, RENE RAMON
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Rodrigo Pérez-Araos
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Fernanda Baus
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Camila Moscoso
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Álvaro Salazar
<jats:p>The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, <jats:italic>p</jats:italic> = 0.013) and associated with lower survival (65.4% vs. 85.7%, <jats:italic>p</jats:italic> = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998–24.731], <jats:italic>p</jats:italic> = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402–5.160], <jats:italic>p</jats:italic> = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.</jats:p>
Scopus© Citations 18 1

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