Prognostic value of elevated cardiac troponin I in ESRD patients with sepsis.
BACKGROUND
Elevated cardiac troponin (cTn) levels have been reported to predict adverse cardiovascular outcomes in asymptomatic ESRD patients. However, the prognostic value of elevated cTn levels associated with sepsis in ESRD patients is unknown. Therefore, this study aimed to elucidate the clinical implications of elevated cTnI levels in ESRD patients with sepsis.


METHODS
Of the 305 ESRD patients in whom cTnI was measured between January 2003 and December 2005, sepsis developed in 121 patients during follow-up. Based on cTnI levels at the onset of sepsis, patients were classified as elevated cTnI group (ET, n = 50, >0.2 ng/ml) and lower cTnI group (LT, n = 71, < or =0.2 ng/ml). Study endpoints were short- and long-term mortality. Short-term mortality was defined as death occurring within 90 days after sepsis, and patients who survived during this period were followed till death after 90 days.


RESULTS
Before sepsis, the median concentration of cTnI was 0.05 (0.01-3.59) ng/ml and it was significantly increased to 0.11 (0.01-22.0) ng/ml when sepsis supervened (P < 0.01). Compared to the LT group, the short-term mortality rate was significantly higher in the ET group (P < 0.05). After adjustment for age, diabetes, serum albumin and CRP levels, presence of shock and previous cardiovascular disease history, the ET group had a greater odds ratio of short-term mortality (OR 5.13, P < 0.01). In addition, the Kaplan-Meier plot for long-term survival revealed a significantly higher mortality rate in the ET group. In a multivariate Cox regression analysis, the elevation of cTnI levels was an independent determinant for long-term mortality (HR 5.90, P < 0.01).


CONCLUSIONS
This study showed that elevated cTnI levels were significantly associated with short- and long-term mortality in ESRD patients with sepsis. Therefore, elevated cTnI levels in these patients should not be overlooked and be followed for adverse outcomes.
Kang
Ea Wha
EW
Department of Internal Medicine, NHIC IIsan Hospital, Goyangshi, Gyunggi-do, Korea.
Na
Hyoung Jung
HJ
Hong
Sug Min
SM
Shin
Sug Kyun
SK
Kang
Shin-Wook
SW
Choi
Kyu Hun
KH
Lee
Ho Yung
HY
Han
Dae-Suk
DS
Han
Seung Hyeok
SH
D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D019210:Troponin I / Q000378:metabolism*
D015415:Biomarkers; D019210:Troponin I