title: Cardiac Troponin Is a Predictor of Septic Shock Mortality in Cancer Patients in an Emergency Department: A Retrospective Cohort Study.
abstract: BACKGROUND
  Septic shock may be associated with myocardial damage; however, the prognostic value of cardiac enzymes in cancer patients with septic shock is unknown. In this study, we evaluated the prognostic significance of cardiac enzymes in combination with established prognostic factors in predicting the 7-day mortality rate of patients with septic shock, and we constructed a new scoring system, Septic Oncologic Patients in Emergency Department (SOPED), which includes cardiac enzymes, to predict 7-day mortality rates.
  
  
  RESULTS
  We performed a retrospective cohort study of 375 adult cancer patients with septic shock who visited the emergency department of a comprehensive cancer center between 01/01/2004 and 12/31/2013. The 7-day and 28-day mortality rates were 19.7% and 37.6%, respectively. The creatine kinase myocardial band fraction and troponin-I were significantly higher in patients who died in ≤7 days and ≤28 days than in those who did not. In Cox regression models, troponin-I >0.05 ng/mL plus Predisposition, Infection, Response, and Organ Failure (PIRO2011) or Mortality in Emergency Department Sepsis (MEDS) score was a significant predictor of survival for ≤7 days. With our new SOPED scoring system, the receiver operating characteristic area under the curve was 0.836, higher than those for PIRO2011 and MEDS.
  
  
  CONCLUSIONS
  Troponin-I >0.05 ng/mL was an important predictor of short-term mortality (≤7 days). The SOPED scoring system, which incorporated troponin-I, was more prognostically accurate than were other scores for 7-day mortality. Large multicenter studies are needed to verify our results and prospectively validate the prognostic performance of the SOPED score.
authors.affiliation: Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, United States of America.|Department of Intensive Care, Guangzhou First People's Hospital, Guangzhou Medical University, 1 Panfu Road, Guangdong, People's Republic of China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, United States of America.
authors.forename: Aiham
authors.initials: A
authors.lastname: Qdaisat
authors.affiliation: Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, United States of America.|Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Rd., West F16, Guangzhou, Guangdong 510060, People's Republic of China.
authors.forename: Zhihuang
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Laboratory Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, United States of America.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wagar
authors.affiliation: Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, United States of America.
authors.forename: Cielito
authors.initials: C
authors.lastname: Reyes-Gibby
authors.affiliation: Laboratory Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, United States of America.
authors.forename: Qing H
authors.initials: QH
authors.lastname: Meng
authors.affiliation: Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, United States of America.|Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, United States of America.
authors.forename: Sai-Ching J
authors.initials: SC
authors.lastname: Yeung
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D016019:Survival Analysis; D019210:Troponin I / Q000032:analysis*
chemical_list: D019210:Troponin I