Relationship of Troponin I in Septic Patients Without Cardiac Disease

Md. Tahsin Salam¹, Kaniz Fatima Bari², Tufael³, Atiqur Rahman Sunny³, Hasibul Hasan⁴

This study showed the Troponin I as a prognostic marker in sepsis patients, guiding risk stratification and improving management for better outcomes.

Abstract

Background: Septic shock, marked by high morbidity and mortality, entails multiple organ dysfunction. Troponin I (TnI), linked to cardiac injury, rises in septic patient’s sans prior cardiac disease, hinting at myocardial involvement. Methods: A prospective analysis was conducted on n=280 samples collected from patients hospitalized between March and February of 2023, who presented with clinical suspicion of infection. TnI levels were measured upon admission, and patient demographics, clinical characteristics, and outcomes were recorded. Results: Among the patients, 45% exhibited elevated TnI levels upon ICU admission. Of these, 65% progressed to severe sepsis or septic shock during their hospital stay. Additionally, 30% of patients with elevated TnI levels experienced adverse outcomes, including increased mortality and prolonged hospitalization. The mean TnI level in septic patients without known cardiac disease was 0.78 ng/mL (standard deviation: 0.32 ng/mL). Elevated TnI levels showed a significant association with sepsis severity, as evidenced by higher Sequential Organ Failure Assessment (SOFA) scores (p < 0.05), increased in-hospital mortality (p < 0.01), and longer ICU stays (p < 0.05). Conclusions: Elevated TnI levels in septic patients without cardiac disease suggest myocardial involvement in sepsis. TnI's association with adverse outcomes highlights its potential as a prognostic marker, warranting further research for clinical implications.

Keywords: Troponin I, sepsis, intensive care unit, myocardial involvement, prognostic marker.

References

Akter, J., Bari, K. F., Salam, M. T., Banik, P. C., Khan, M. S. S., & Sunny, A. R. Significance of Serum Biomarkers in Early Diagnosis of Hepatocellular Carcinoma in Patient with Fisher Groups.

Alagna, L., Meessen, J. M., Bellani, G., Albiero, D., Caironi, P., Principale, I., ... & Latini, R. (2021). Higher levels of IgA and IgG at sepsis onset are associated with higher mortality: results from the Albumin Italian Outcome Sepsis (ALBIOS) trial. Annals of intensive care, 11, 1-9.

Andreis, D. T., & Singer, M. (2016). Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum. Intensive care medicine, 42, 1387-1397.

Bari, K. F., Salam, M. T., Hasan, S. E., & Sunny, A. R. (2023). Serum zinc and calcium level in patients with psoriasis. Journal of Knowledge Learning and Science Technology ISSN: 2959-6386 (online), 2(3), 7-14.

Chen, H., Zhang, Y., Li, S., Li, N., Chen, Y., Zhang, B., ... & Dai, M. (2018). Direct comparison of five serum biomarkers in early diagnosis of hepatocellular carcinoma. Cancer management and research, 1947-1958.

Chowdhury, N. U., Tisha, A., Sarker, J., Nath, P. D., Ahmed, N., Abdullah, S., ... & Sagor, M. A. T. (2018). Targeting inducible Nitric Oxide Synthase (iNOS) in the prevention of vascular damage and cardiac inflammation. J. Angiotherapy, 2(1), 067-077.

Faruk, O., Hasan, S. E., Jubayer, A., Akter, K., Al Shiam, S. A., Rahman, K., & Ali, M. Y. (2023). Microbial Isolates from Urinary Tract Infection and their Antibiotic Resistance Pattern in Dhaka city of Bangladesh. Journal of Knowledge Learning and Science Technology ISSN: 2959-6386 (online), 2(3), 76-87.

Fleischmann, C., Scherag, A., Adhikari, N. K., Hartog, C. S., Tsaganos, T., Schlattmann, P., ... & Reinhart, K. (2016). Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. American journal of respiratory and critical care medicine, 193(3), 259-272.

Guo, J., & Wang, Y. (2015). A study on the correlation between serum procalcitonin and cardiac troponin I levels in patients with sepsis. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care, 527-530.

Hasan, S. E., Jubayer, A., Akter, K., Akter, A., Akter, F., Al Shiam, S. A., & Sunny, A. R. (2023). Effects of Nigella Sativa and Syzygium Cumini Seed Extracts on Blood Glucose Levels in Swiss Albino Mice. Journal of Knowledge Learning and Science Technology ISSN: 2959-6386 (online), 2(3), 53-62.

Hollenberg, S. M., & Singer, M. (2021). Pathophysiology of sepsis-induced cardiomyopathy. Nature Reviews Cardiology, 18(6), 424-434.

Khan, Z. F., & Alotaibi, S. R. (2020). Applications of artificial intelligence and big data analytics in m-health: A healthcare system perspective. Journal of healthcare engineering, 2020(1), 8894694.

Landesberg, G., Jaffe, A. S., Gilon, D., Levin, P. D., Goodman, S., Abu-Baih, A., ... & Landesberg, A. (2014). Troponin elevation in severe sepsis and septic shock: the role of left ventricular diastolic dysfunction and right ventricular dilatation. Critical care medicine, 42(4), 790-800.

Machado, J. R., Soave, D. F., da Silva, M. V., de Menezes, L. B., Etchebehere, R. M., dos Reis Monteiro, M. L. G., ... & Celes, M. R. N. (2014). Neonatal sepsis and inflammatory mediators. Mediators of inflammation, 2014(1), 269681.

Mire, S. K., & Sahu, D. K. Evaluation of Cardiac Reserve Using Echocardiography for The Detection of Mild Cardiac Dysfunction in Mice–A Review.

Pandompatam, G., Kashani, K., & Vallabhajosyula, S. (2019). The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock. Revista Brasileira de terapia intensiva, 31, 368-378.

Qaddoori, H. T., Mohammed, F. M., & Abdullah, A. N. Novel Cardiac Biomarkers H-FABP and GPBB for Early Detection and Prognosis of Acute Myocardial Infarction.

Radhika, R., & Mahajan, R. A Novel Framework of Hybrid Optimization Techniques for Contrast-Enhancement in Cardiac MRI Medical Images.

Rahman, M. T. (2024). Comparison of Outcome of Concurrent Chemoradiotherapy and Sequential Chemoradiotherapy in Locally Advanced, Inoperable Squamous Cell Carcinoma of Head and Neck Region. Saudi J Med Pharm Sci, 10(5), 293-300.

Rudiger, A., Jeger, V., Arrigo, M., Schaer, C. A., Hildenbrand, F. F., Arras, M., ... & Bettex, D. (2018). Heart rate elevations during early sepsis predict death in fluid-resuscitated rats with fecal peritonitis. Intensive care medicine experimental, 6, 1-13.

Sheyin, O., Davies, O., Duan, W., & Perez, X. (2015). The prognostic significance of troponin elevation in patients with sepsis: a meta-analysis. Heart & Lung, 44(1), 75-81.

Singer, M. (2014). The role of mitochondrial dysfunction in sepsis-induced multi-organ failure. Virulence, 5(1), 66-72.

Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., ... & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama, 315(8), 801-810.

Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., & White, H. D. (2019). Fourth universal definition of myocardial infarction (2018). European heart journal, 40(3), 237-269.

Vallabhajosyula, S., Sakhuja, A., Geske, J. B., Kumar, M., Poterucha, J. T., Kashyap, R., ... & Jentzer, J. C. (2017). Role of admission troponin-T and serial troponin-T testing in predicting outcomes in severe sepsis and septic shock. Journal of the American Heart Association, 6(9), e005930.

Vallabhajosyula, S., Sakhuja, A., Geske, J. B., Kumar, M., Poterucha, J. T., Kashyap, R., ... & Jentzer, J. C. (2017). Role of admission troponin-T and serial troponin-T testing in predicting outcomes in severe sepsis and septic shock. Journal of the American Heart Association, 6(9), e005930.

Wilhelm, J., Hettwer, S., Schuermann, M., Bagger, S., Gerhardt, F., Mundt, S., ... & Werdan, K. (2014). Elevated troponin in septic patients in the emergency department: frequency, causes, and prognostic implications. Clinical Research in Cardiology, 103, 561-567.

Zhao, H., Zhao, Y., Yan, N., Wang, Y., Li, W., Zhao, J., ... & Liu, X. (2023). Metagenomic next-generation sequencing of bronchoalveolar lavage fluid in non-severe and severe pneumonia patients. Journal of Microbiological Methods, 215, 106848.

Zochios, V., & Valchanov, K. (2015). Raised cardiac troponin in intensive care patients with sepsis, in the absence of angiographically documented coronary artery disease: A systematic review. Journal of the Intensive Care Society, 16(1), 52-57.

Zotova, L. (2023). Immune checkpoint inhibitors-related myocarditis: a review of reported clinical cases. Diagnostics, 13(7), 1243.