Frencken Jos F, Donker Dirk W, Spitoni Cristian, Koster-Brouwer Marlies E, Soliman Ivo W, Ong David S Y, Horn Janneke, van der Poll Tom, van Klei Wilton A, Bonten Marc J M, Cremer Olaf L
From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands.
Circ Cardiovasc Qual Outcomes. 2018 Feb;11(2):e004040. doi: 10.1161/CIRCOUTCOMES.117.004040.
Sepsis is frequently complicated by the release of cardiac troponin, but the clinical significance of this myocardial injury remains unclear. We studied the associations between troponin release during sepsis and 1-year outcomes.
We enrolled consecutive patients with sepsis in 2 Dutch intensive care units between 2011 and 2013. Subjects with a clinically apparent cause of troponin release were excluded. High-sensitivity cardiac troponin I (hs-cTnI) concentration in plasma was measured daily during the first 4 intensive care unit days, and multivariable Cox regression analysis was used to model its association with 1-year mortality while adjusting for confounding. In addition, we studied cardiovascular morbidity occurring during the first year after hospital discharge. Among 1258 patients presenting with sepsis, 1124 (89%) were eligible for study inclusion. Hs-cTnI concentrations were elevated in 673 (60%) subjects on day 1, and 755 (67%) ever had elevated levels in the first 4 days. Cox regression analysis revealed that high hs-cTnI concentrations were associated with increased death rates during the first 14 days (adjusted hazard ratio, 1.72; 95% confidence interval, 1.14-2.59 and hazard ratio, 1.70; 95% confidence interval, 1.10-2.62 for hs-cTnI concentrations of 100-500 and >500 ng/L, respectively) but not thereafter. Furthermore, elevated hs-cTnI levels were associated with the development of cardiovascular disease among 200 hospital survivors who were analyzed for this end point (adjusted subdistribution hazard ratio, 1.25; 95% confidence interval, 1.04-1.50).
Myocardial injury occurs in the majority of patients with sepsis and is independently associated with early-but not late-mortality, as well as postdischarge cardiovascular morbidity.
脓毒症常并发心肌肌钙蛋白释放，但这种心肌损伤的临床意义仍不明确。我们研究了脓毒症期间肌钙蛋白释放与1年预后之间的关联。
2011年至2013年期间，我们在荷兰的2个重症监护病房纳入了连续的脓毒症患者。排除有明显肌钙蛋白释放临床病因的受试者。在重症监护病房的前4天每天测量血浆中的高敏心肌肌钙蛋白I（hs-cTnI）浓度，并采用多变量Cox回归分析对其与1年死亡率的关联进行建模，同时调整混杂因素。此外，我们研究了出院后第一年发生的心血管疾病发病率。在1258例脓毒症患者中，1124例（89%）符合研究纳入标准。第1天，673例（60%）受试者的hs-cTnI浓度升高，755例（67%）在最初4天内曾有浓度升高。Cox回归分析显示，高hs-cTnI浓度与前14天内死亡率增加相关（调整后的风险比，1.72；95%置信区间，1.14 - 2.59；hs-cTnI浓度分别为100 - 500和>500 ng/L时的风险比，1.70；95%置信区间，1.10 - 2.62），但此后无相关性。此外，在针对这一终点进行分析的200例医院幸存者中，hs-cTnI水平升高与心血管疾病的发生相关（调整后的亚分布风险比，1.25；95%置信区间，1.04 - 1.50）。
大多数脓毒症患者会发生心肌损伤，且与早期而非晚期死亡率以及出院后心血管疾病发病率独立相关。
