Among patients with no known prior cardiovascular disease (CVD), modestly elevated troponin I levels during sepsis have been associated with an increased risk for experiencing adverse CV events in the year following hospitalization for sepsis. A retrospective cohort study was conducted in patients who had survived to hospital discharge following an index hospitalization for sepsis in 1 of 21 Kaiser Permanente Northern California hospitals from January 1, 2011, through September 30, 2017. Results of the analysis were published in the American Journal of Respiratory and Critical Care Medicine.
The study authors sought to assess the link between serum troponin levels during sepsis and 1-year post-sepsis CV events. Adult patients aged 40 years and older with no preexisting CVD within 5 years who were hospitalized for sepsis were evaluated. The composite study outcome included the following: (1) atherosclerotic CVD (ASCVD), which was defined as acute myocardial infarction, ischemic stroke, or coronary revascularization; (2) diagnosis of acute heart failure (HF); and (3) diagnosis of atrial fibrillation (AF) that occurred within the year following the sepsis hospital discharge.
Patients’ peak serum troponin I levels during sepsis were categorized as normal (≤0.04 ng/mL) or within tertiles of abnormal (tertile 1: >0.04 to ≤0.9 ng/mL, tertile 2: >0.09 ng/mL to ≤0.42 ng/mL, or tertile 3: >0.42 ng/mL).
Among 82,748 individuals who fulfilled sepsis criteria, a total of 14,046 did not have a prior diagnosis of ASCVD, HF, or AF within 5 years of being hospitalized for sepsis, had their troponin I levels measured, and thus were included in the primary analysis. The median patient age was 75 years (interquartile range, 65-84 years); 47% of the individuals were men and 62% were White.
In 54.4% (7643 of 14,046) of the patients, the maximum 14-day troponin level was normal. The time from hospital admission to peak troponin I level was a median of 0 days (interquartile range, 0-1 day). Although none of the patients had prior diagnosis codes for CVD, 71% were prescribed antihypertensive agents, 41% statin therapy, 2% aspirin, and 1.6 other antiplatelet treatments before their index sepsis hospitalization.
Following their index hospitalization for sepsis, all patients were observed for 1 year. During this time, 14.3% (2012 of 14,046) of patients experienced the composite CV outcome — 479 with ASCVD events, 1425 with AF, and 345 with HF. The composite outcome was reported in 832 patients with normal troponin levels, compared with 370 individuals with abnormal troponin tertile 1 levels, 376 patients with abnormal troponin tertile 2 levels, and 434 patients with abnormal troponin tertile 3 levels (P <.001). Patients within elevated troponin tertiles had increased risks for adverse CV events: (1) tertile 1: adjusted hazard ratio (aHR), 1.37; 95% CI, 1.20-1.55, (2) tertile 2: aHR, 1.44; 95% CI, 1.27-1.63, and (3) tertile 3: aHR, 1.77; 95% CI, 1.56-2.00.
The researchers concluded that based on their findings, strategies designed to mitigate CV complications among this high-risk group of patients are warranted. Elevated troponin I levels during sepsis may be used in future prospective studies, along with traditional CV risk factors, to evaluate post-sepsis CV therapies in this population.
Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Garcia MA, Rucci JM, Thai KK, et al. Association between troponin I levels during sepsis and post-sepsis cardiovascular complications. Am J Respir Crit Care Med. Published online May 26, 2021. doi:10.1164/rccm.202103-0613OC