Choi Eun-Jeong, Nam Hyunseung, Chung Chi Ryang, Yang Jeong Hoon, Suh Gee Young, Park Sunghoon, Lee Su Yeon, Hyun Dong-Gon, Park Mi Hyeon, Lim Chae-Man, Ko Ryoung-Eun
Department of Critical Care Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea.
Division of Cardiology, Department of Medicine, Samsung Medical Center Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine Seoul South Korea.
J Am Heart Assoc. 2025 May 6;14(9):e038651. doi: 10.1161/JAHA.124.038651. Epub 2025 Apr 16.
Sepsis-induced cardiac dysfunction, known as septic cardiomyopathy, is a common complication associated with increased mortality. Cardiac troponins serve as markers for myocardial injury and are frequently elevated in patients with sepsis. However, the role of troponin elevation at sepsis recognition in risk stratification remains controversial.
This nationwide multicenter prospective cohort study analyzed 2141 adult patients with sepsis without prior cardiovascular disease from the Korean Sepsis Alliance registry. These patients were classified as having either elevated troponin levels or troponin levels in the normal range at the time of sepsis recognition, according to the reference ranges specific to each participating institution. The primary outcome was hospital mortality, and propensity score matching was used to control for confounding factors. In the propensity score-matched cohort (523 pairs), there were no significant differences in hospital mortality (35.2% versus 32.7%, odds ratio [OR], 1.12 [95% CI, 0.86-1.44], =0.396), hospital length of stay (13.0 versus 15.0 days, OR, 1.00 [95% CI, 0.99-1.00], =0.128), intensive care unit mortality (24.7% versus 25.0%, OR, 0.98 [95% CI, 0.74-1.30], =0.886), or intensive care unit length of stay between the elevated troponin and control groups. However, landmark analysis revealed that the elevated troponin group had a lower survival probability after 1 week (log-rank =0.033) and significantly higher kidney Sequential Organ Failure Assessment scores from intensive care unit admission to day 7 (=0.003).
Troponin elevation at sepsis recognition was not significantly associated with increased hospital mortality or worse clinical outcomes in patients with sepsis.
脓毒症诱导的心脏功能障碍，即脓毒症性心肌病，是一种常见并发症，与死亡率增加相关。心肌肌钙蛋白作为心肌损伤的标志物，在脓毒症患者中经常升高。然而，在脓毒症识别时肌钙蛋白升高在风险分层中的作用仍存在争议。
这项全国性多中心前瞻性队列研究分析了来自韩国脓毒症联盟登记处的2141例无既往心血管疾病的成年脓毒症患者。根据每个参与机构特定的参考范围，这些患者在脓毒症识别时被分类为肌钙蛋白水平升高或肌钙蛋白水平在正常范围内。主要结局是医院死亡率，并使用倾向评分匹配来控制混杂因素。在倾向评分匹配队列（523对）中，医院死亡率（35.2%对32.7%，比值比[OR]，1.12[95%CI，0.86 - 1.44]，P = 0.396）、住院时间（13.0天对15.0天，OR，1.00[95%CI，0.99 - 1.00]，P = 0.128）、重症监护病房死亡率（24.7%对25.0%，OR，0.98[95%CI，0.74 - 1.30]，P = 0.886）或重症监护病房住院时间在肌钙蛋白升高组和对照组之间无显著差异。然而，标志性分析显示，肌钙蛋白升高组在1周后的生存概率较低（对数秩检验P = 0.033），并且从重症监护病房入院到第7天肾脏序贯器官衰竭评估评分显著更高（P = 0.003）。
脓毒症识别时肌钙蛋白升高与脓毒症患者医院死亡率增加或更差的临床结局无显著关联。
