Association between Troponin I Levels during Sepsis and Postsepsis Cardiovascular Complications
Michael A. Garcia, Justin M. Rucci, Khanh K. Thai, Yun Lu, Patricia Kipnis, Alan S. Go, Manisha Desai, Nicholas A. Bosch, Adriana Martínez Arias, Heather Clancy, Ycar Devis, Laura C. Myers, Vincent X. Liu, Allan J. Walkey
Abstract
Abstract Rationale Sepsis commonly results in elevated serum troponin levels and increased risk for postsepsis cardiovascular complications; however, the association between troponin levels during sepsis and cardiovascular complications after sepsis is unclear. Objectives To evaluate the association between serum troponin levels during sepsis and 1 year after sepsis cardiovascular events. Methods We analyzed adults aged ⩾40 years without preexisting cardiovascular disease within 5 years, admitted with sepsis across 21 hospitals from 2011 to 2017. Peak serum troponin I levels during sepsis were grouped as normal (⩽0.04 ng/ml) or tertiles of abnormal (>0.04 to ⩽0.09 ng/ml, >0.09 to ⩽0.42 ng/ml, or >0.42 ng/ml). Multivariable adjusted cause-specific Cox proportional hazards models with death as a competing risk were used to assess associations between peak troponin I levels and a composite cardiovascular outcome (atherosclerotic cardiovascular disease, atrial fibrillation, and heart failure) in the year following sepsis. Models were adjusted for presepsis and intrasepsis factors considered potential confounders. Measurements and Main Results Among 14,046 eligible adults with troponin I measured, 2,012 (14.3%) experienced the composite cardiovascular outcome, including 832 (10.9%) patients with normal troponin levels, as compared with 370 (17.3%), 376 (17.6%), and 434 (20.3%) patients within each sequential abnormal troponin tertile, respectively (P < 0.001). Patients within the elevated troponin tertiles had increased risks of adverse cardiovascular events (adjusted hazard ratio [aHR]troponin0.04–0.09 = 1.37; 95% confidence interval [CI], 1.20–1.55; aHRtroponin0.09–0.42 = 1.44; 95% CI, 1.27–1.63; and aHRtroponin>0.42 = 1.77; 95% CI, 1.56–2.00). Conclusions Among patients without preexisting cardiovascular disease, troponin elevation during sepsis identified patients at increased risk for postsepsis cardiovascular complications. Strategies to mitigate cardiovascular complications among this high-risk subset of patients are warranted.