Garcia Michael A, Rucci Justin M, Thai Khanh K, Lu Yun, Kipnis Patricia, Go Alan S, Desai Manisha, Bosch Nicholas A, Martinez Adriana, Clancy Heather, Devis Ycar, Myers Laura C, Liu Vincent X, Walkey Allan J
The Pulmonary Center, Section of Pulmonary, Allergy, Sleep, and Critical Care, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Am J Respir Crit Care Med. 2021 Sep 1;204(5):557-565. doi: 10.1164/rccm.202103-0613OC.
Sepsis commonly results in elevated serum troponin levels and increased risk for postsepsis cardiovascular complications; however, the association between troponin levels during sepsis and cardiovascular complications after sepsis is unclear. To evaluate the association between serum troponin levels during sepsis and 1 year after sepsis cardiovascular events. We analyzed adults aged ⩾40 years without preexisting cardiovascular disease within 5 years, admitted with sepsis across 21 hospitals from 2011 to 2017. Peak serum troponin I levels during sepsis were grouped as normal (⩽0.04 ng/ml) or tertiles of abnormal (>0.04 to ⩽0.09 ng/ml, >0.09 to ⩽0.42 ng/ml, or >0.42 ng/ml). Multivariable adjusted cause-specific Cox proportional hazards models with death as a competing risk were used to assess associations between peak troponin I levels and a composite cardiovascular outcome (atherosclerotic cardiovascular disease, atrial fibrillation, and heart failure) in the year following sepsis. Models were adjusted for presepsis and intrasepsis factors considered potential confounders. Among 14,046 eligible adults with troponin I measured, 2,012 (14.3%) experienced the composite cardiovascular outcome, including 832 (10.9%) patients with normal troponin levels, as compared with 370 (17.3%), 376 (17.6%), and 434 (20.3%) patients within each sequential abnormal troponin tertile, respectively ( < 0.001). Patients within the elevated troponin tertiles had increased risks of adverse cardiovascular events (adjusted hazard ratio [aHR] = 1.37; 95% confidence interval [CI], 1.20-1.55; aHR = 1.44; 95% CI, 1.27-1.63; and aHR = 1.77; 95% CI, 1.56-2.00). Among patients without preexisting cardiovascular disease, troponin elevation during sepsis identified patients at increased risk for postsepsis cardiovascular complications. Strategies to mitigate cardiovascular complications among this high-risk subset of patients are warranted.
脓毒症通常会导致血清肌钙蛋白水平升高以及脓毒症后心血管并发症风险增加；然而，脓毒症期间肌钙蛋白水平与脓毒症后心血管并发症之间的关联尚不清楚。为了评估脓毒症期间血清肌钙蛋白水平与脓毒症后1年心血管事件之间的关联。我们分析了2011年至2017年期间在21家医院因脓毒症入院的5年内无心血管疾病史的40岁及以上成年人。脓毒症期间血清肌钙蛋白I峰值水平分为正常（≤0.04 ng/ml）或异常三分位数（>0.04至≤0.09 ng/ml、>0.09至≤0.42 ng/ml或>0.42 ng/ml）。使用以死亡作为竞争风险的多变量调整特定病因Cox比例风险模型来评估脓毒症后1年肌钙蛋白I峰值水平与复合心血管结局（动脉粥样硬化性心血管疾病、心房颤动和心力衰竭）之间的关联。模型针对被视为潜在混杂因素的脓毒症前和脓毒症期间因素进行了调整。在14046名测量了肌钙蛋白I的符合条件的成年人中，2012人（14.3%）发生了复合心血管结局，其中肌钙蛋白水平正常的患者有832人（10.9%），而在肌钙蛋白异常三分位数中，依次分别有370人（17.3%）、376人（17.6%）和434人（20.3%）（P<0.001）。肌钙蛋白三分位数升高的患者发生不良心血管事件的风险增加（调整后风险比[aHR]=1.37；95%置信区间[CI]，1.20-1.55；aHR=1.44；95%CI，1.27-1.63；aHR=1.77；95%CI，1.56-2.00）。在无心血管疾病史的患者中，脓毒症期间肌钙蛋白升高表明脓毒症后心血管并发症风险增加。有必要采取策略减轻这一高危患者亚组的心血管并发症。
