Evaluation of Cardiac Troponin I as a Predictor of Outcome of Sepsis in Critically Ill Patients

Abstract

Sepsis and septic shock are the most common causes of morbidity and mortality in intensive care units in the United States. The cardiovascular abnormalities associated with septic shock, in large part, account for the life-threatening nature of the syndrome. Cardiac troponin I (cTnI) has been shown to be an indicator of myocardial injury and is an accepted prognostic factor of myocardial infarction (MI). Although cTnI is cardiac-specific, its release seems not to be limited to cardiac-related events, but is also detectable in other critical clinical conditions, such as trauma, pulmonary embolism, and severe sepsis. The elevation of cardiac troponins in patients with sepsis, severe sepsis and septic shock has been shown to indicate a poor prognosis. Troponin release in this population occurs in the absence of flow-limiting coronary artery disease, suggesting the presence of mechanisms other than thrombotic coronary artery occlusion, probably a transient loss in membrane integrity with subsequent troponin release or microvascular thrombotic injury.