Early high-sensitivity troponin elevation and short-term mortality in sepsis: a systematic review with meta-analysis
Journal
Critical Care
ISSN
1364-8535
Date Issued
2025-02-14
Author(s)
Abraham I. J. Gajardo
Santiago Ferrière-Steinert
Joaquín Valenzuela Jiménez
Sebastián Heskia Araya
Thomas Kouyoumdjian Carvajal
José Ramos-Rojas
Juan Nicolás Medel
Type
journal-article
URL Institutional Repository
Abstract
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
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
Subjects
biomarkers
;
humans
;
sepsis
;
troponin
;
troponin
;
biological marker
;
troponin
;
apache
;
article
;
cardiomyopathy
;
disease severity
;
follow up
;
human
;
in-hospital mortality
;
limit of detection
;
meta analysis
;
mortality
;
mortality rate
;
mortality risk
;
prognosis
;
risk assessment
;
sepsis
;
septic shock
;
sequential organ failure assessment score
;
short term mortality
;
simplified acute physiology score
;
systematic review
;
blood
;
mortality
;
high-sensitivity troponin
;
meta-analysis
;
prognosis
;
prognostic factor
;
sepsis
;
septic cardiomyopathy
;
septic shock
;
systematic review
;
troponin