title: Elevated troponin in septic patients in the emergency department: frequency, causes, and prognostic implications.
abstract: BACKGROUND
  According to the "Third Universal Definition of Myocardial Infarction", cardiac troponin (cTn) is defined to be elevated, if the value is above the 99th percentile of a normal reference population. Especially in emergency medicine, this leads to pathological values more often than before this definition has been founded. Severe sepsis and septic shock frequently cause a rise of cTn, but there is only limited data about its role in septic patients in the emergency department (ED). Therefore, we investigated the frequency, main causes, and prognostic relevance of elevated high-sensitive troponin T (hsTnT) in septic patients in the ED.
  
  
  METHODS
  Adults presenting at the ED with sepsis were included in the study. HsTnT was measured soon after admission. Main influencing factors were investigated, and the prognostic value was evaluated.
  
  
  RESULTS
  197 of the 313 analysed patients (62.9 %) showed an elevated hsTnT, with significantly higher rates in patients with severe sepsis and septic shock than in uncomplicated sepsis. APACHE II score, creatinine, and coronary heart disease were found to influence hsTnT independently. Nevertheless, patients with uncomplicated sepsis and without relevant renal insufficiency also showed notable rates of elevated hsTnT: 51.6 % (uncomplicated sepsis) and 34.5 % (no relevant renal failure), respectively. HsTnT showed a prognostic value with higher levels in non-survivors and an AUC of 0.72, p < 0.001.
  
  
  CONCLUSIONS
  In the ED, sepsis is a relevant cause of elevated cTn, which underlines the role of sepsis as a differential diagnosis in non-ACS patients with positive cTn. A rise of cTn may be an indicator of poor outcome.
authors.affiliation: Department of Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany, joachim.wilhelm@uk-halle.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Wilhelm
authors.forename: Stefan
authors.initials: S
authors.lastname: Hettwer
authors.forename: Markus
authors.initials: M
authors.lastname: Schuermann
authors.forename: Silke
authors.initials: S
authors.lastname: Bagger
authors.forename: Franziska
authors.initials: F
authors.lastname: Gerhardt
authors.forename: Sandra
authors.initials: S
authors.lastname: Mundt
authors.forename: Susanne
authors.initials: S
authors.lastname: Muschik
authors.forename: Julia
authors.initials: J
authors.lastname: Zimmermann
authors.forename: Mroawan
authors.initials: M
authors.lastname: Amoury
authors.forename: Henning
authors.initials: H
authors.lastname: Ebelt
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
mesh_terms: D018806:APACHE; D000368:Aged; D003404:Creatinine / Q000378:metabolism; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000503:physiopathology; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis* / Q000503:physiopathology; D020107:Troponin T / Q000032:analysis*
chemical_list: D020107:Troponin T; D003404:Creatinine