Elevated troponin I levels during sepsis may indicate risk for postsepsis CV complications

A U.S. retrospective study looked at rates of atherosclerotic disease, atrial fibrillation, and heart failure in the year after sepsis in patients with elevated troponin I levels and no previous diagnosis of cardiovascular (CV) disease.

Serum troponin I levels may be related to cardiovascular risk one year postsepsis, a recent study found.

Researchers performed a retrospective cohort study of patients without a previous recent diagnosis of cardiovascular disease who were admitted with sepsis at 21 U.S. hospitals from 2011 to 2017. Peak serum troponin I levels during sepsis were classified as normal (<0.04 ng/mL) or in tertiles of abnormal (>0.04 to ≤0.09 ng/mL, >0.09 to ≤0.42 ng/mL, or >0.42 ng/mL). Associations between peak sepsis troponin I levels and a composite cardiovascular outcome of atherosclerotic disease, atrial fibrillation, and heart failure in the year after sepsis were assessed using multivariable adjusted, cause-specific Cox proportional hazards models that treated death as a competing risk. The study results were published online May 26 by the American Journal of Respiratory and Critical Care Medicine.

Overall, 14,046 patients with troponin I levels measured during sepsis were included in the study. Median age was 75 years, 47% of patients were men, and 62% were White. A total of 2,012 patients (14.3%) developed the composite cardiovascular outcome in the year after sepsis hospitalization, 839 (10.9%) with normal troponin levels, 370 (17.3%) in tertile 1, 376 (17.6%) in tertile 2, and 434 (20.3%) in tertile 3 (P<0.001 for all comparisons). Compared with patients who had normal troponin I levels during sepsis, those with elevated levels had increased risks of adverse cardiovascular events one year later (adjusted hazard ratios by tertile, 1.37 [95% CI, 1.20 to 1.55], 1.44 [95% CI, 1.27 to 1.63], and 1.77 [95% CI, 1.56 to 2.00], respectively).

The study was limited by its retrospective design and the fact that it did not address long-term cardiovascular risk, among other factors, the authors noted. They concluded that in patients with no preexisting cardiovascular disease, modestly elevated troponin I levels during sepsis could indicate risk for future cardiovascular complications. “Elevated troponin I during sepsis may be used in future prospective studies along with traditional cardiovascular risk factors to target high-risk patients for evaluation of post-sepsis cardio-protective therapies,” they wrote.