Troponin-I as a prognosticator of mortality in severe sepsis patients.
OBJECTIVE
The purpose of this retrospective study was to evaluate cardiac troponin-I (cTnI) as a 28-day mortality prognosticator and predictor for a drotrecogin alfa (activated) (DrotAA) survival benefit in recombinant human activated Protein C Worldwide Evaluation in Severe Sepsis patients.


METHODS
Cardiac troponin-I was measured using the Access AccuTnI Troponin I assay (Beckman Coulter, Fullerton, CA). There were 598 patients (305 DrotAA, 293 placebo) with baseline cTnI data (cTnI negative [<0.06 ng/mL], n = 147; cTnI positive [>or=0.06 ng/mL], n = 451).


RESULTS
Cardiac troponin-I-positive patients were older (mean age, 61 vs 56 years; P = .002), were sicker (mean Acute Physiology and Chronic Health Evaluation II, 26.1 vs 22.3; P < .001), had lower baseline protein C levels (mean level, 49% vs 56%; P = .017), and had higher 28-day mortality (32% vs 14%, P < .0001) than cTnI-negative patients. Elevated cTnI was an independent prognosticator of mortality (odds ratio, 2.020; 95% confidence interval, 1.153-3.541) after adjusting for other significant variables. Breslow-Day interaction test between cTnI levels and treatment was not significant (P = .65).


CONCLUSIONS
This is the largest severe sepsis study reporting an association between elevated cTnI and higher mortality. Cardiac troponin-I elevation was not predictive of a survival benefit with DrotAA treatment.
University of Oklahoma Health Sciences Center, Pulmonary/Critical Care Medicine, Oklahoma City, OK 73104, USA. jijo-john@ouhsc.edu
Jijo
J
John
D Bradley
DB
Woodward
Yanping
Y
Wang
S Betty
SB
Yan
Diana
D
Fisher
Gary T
GT
Kinasewitz
Darell
D
Heiselman
D018806:APACHE; D000367:Age Factors; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D011486:Protein C / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D012720:Severity of Illness Index; D019210:Troponin I / Q000097:blood*
D000890:Anti-Infective Agents; D015415:Biomarkers; D011486:Protein C; D011994:Recombinant Proteins; D019210:Troponin I; C421124:drotrecogin alfa activated