Association between Troponin I Levels during Sepsis and Postsepsis Cardiovascular Complications
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. To evaluate the association between serum troponin levels...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2021-09, Vol.204 (5), p.557-565 |
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| creator | Garcia, Michael A Rucci, Justin M Thai, Khanh K Lu, Yun Kipnis, Patricia Go, Alan S Desai, Manisha Bosch, Nicholas A Martinez, Adriana Clancy, Heather Devis, Ycar Myers, Laura C Liu, Vincent X Walkey, Allan J |
| description | 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.
To evaluate the association between serum troponin levels during sepsis and 1 year after sepsis cardiovascular events.
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.
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 (
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| doi_str_mv | 10.1164/rccm.202103-0613OC |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8491250</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2573890002</sourcerecordid><originalsourceid>FETCH-LOGICAL-c430t-66c858ef17d155423436a7a0b5a0bb1714e7312f1ee0babb6c3bd9959d1b363d3</originalsourceid><addsrcrecordid>eNpdkV1rFTEQhoMo9kP_gBcS8MabrTOZZD9uhLJULRyoYAXvQjabU1N2kzXZPcV_79atRb0IkzDPvGR4GHuFcIZYynfJ2vFMgECgAkqkq_YJO0ZFqpBNBU_XO1RUSNl8O2InOd8CoKgRnrMjkkB1BXjM9HnO0Xoz-xh45-Y75wK_TnGKwQd-yXfu4IbM-yX5cMO_uCn7zE3o-eeY57w9W5N6Hw8m22UwibdxnAZvf0fmF-zZ3gzZvXyop-zrh4vr9lOxu_p42Z7vCisJ5qIsba1qt8eqR6WkIEmlqQx0aj0dVihdRSj26Bx0putKS13fNKrpsaOSejpl77fcaelG11sX5mQGPSU_mvRTR-P1v53gv-ubeNC1bFAoWAPePgSk-GNxedajz9YNgwkuLlkLRURYKdms6Jv_0Nu4pLCut1IV1Q0AiJUSG2VTzDm5_eNnEPS9P33vT2_-9OZvHXr99xqPI3-E0S9eR5kW</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2573890002</pqid></control><display><type>article</type><title>Association between Troponin I Levels during Sepsis and Postsepsis Cardiovascular Complications</title><source>MEDLINE</source><source>American Thoracic Society Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Garcia, Michael A ; Rucci, Justin M ; Thai, Khanh K ; Lu, Yun ; Kipnis, Patricia ; Go, Alan S ; Desai, Manisha ; Bosch, Nicholas A ; Martinez, Adriana ; Clancy, Heather ; Devis, Ycar ; Myers, Laura C ; Liu, Vincent X ; Walkey, Allan J</creator><creatorcontrib>Garcia, Michael A ; Rucci, Justin M ; Thai, Khanh K ; Lu, Yun ; Kipnis, Patricia ; Go, Alan S ; Desai, Manisha ; Bosch, Nicholas A ; Martinez, Adriana ; Clancy, Heather ; Devis, Ycar ; Myers, Laura C ; Liu, Vincent X ; Walkey, Allan J</creatorcontrib><description>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.
To evaluate the association between serum troponin levels during sepsis and 1 year after sepsis cardiovascular events.
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.
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 (
< 0.001). Patients within the elevated troponin tertiles had increased risks of adverse cardiovascular events (adjusted hazard ratio [aHR]
= 1.37; 95% confidence interval [CI], 1.20-1.55; aHR
= 1.44; 95% CI, 1.27-1.63; and aHR
= 1.77; 95% CI, 1.56-2.00).
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.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.202103-0613OC</identifier><identifier>PMID: 34038701</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biomarkers - blood ; Cardiac arrhythmia ; Cardiovascular disease ; Cohort Studies ; Female ; Heart Diseases - etiology ; Humans ; Male ; Middle Aged ; Morbidity ; Original ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sepsis ; Sepsis - blood ; Sepsis - complications ; Studies ; Survivors - statistics & numerical data ; Time Factors ; Troponin I - blood ; United States</subject><ispartof>American journal of respiratory and critical care medicine, 2021-09, Vol.204 (5), p.557-565</ispartof><rights>Copyright American Thoracic Society Sep 1, 2021</rights><rights>Copyright © 2021 by the American Thoracic Society 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c430t-66c858ef17d155423436a7a0b5a0bb1714e7312f1ee0babb6c3bd9959d1b363d3</citedby><cites>FETCH-LOGICAL-c430t-66c858ef17d155423436a7a0b5a0bb1714e7312f1ee0babb6c3bd9959d1b363d3</cites><orcidid>0000-0002-6400-6060 ; 0000-0002-2872-3388 ; 0000-0001-6504-2234</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,4025,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34038701$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garcia, Michael A</creatorcontrib><creatorcontrib>Rucci, Justin M</creatorcontrib><creatorcontrib>Thai, Khanh K</creatorcontrib><creatorcontrib>Lu, Yun</creatorcontrib><creatorcontrib>Kipnis, Patricia</creatorcontrib><creatorcontrib>Go, Alan S</creatorcontrib><creatorcontrib>Desai, Manisha</creatorcontrib><creatorcontrib>Bosch, Nicholas A</creatorcontrib><creatorcontrib>Martinez, Adriana</creatorcontrib><creatorcontrib>Clancy, Heather</creatorcontrib><creatorcontrib>Devis, Ycar</creatorcontrib><creatorcontrib>Myers, Laura C</creatorcontrib><creatorcontrib>Liu, Vincent X</creatorcontrib><creatorcontrib>Walkey, Allan J</creatorcontrib><title>Association between Troponin I Levels during Sepsis and Postsepsis Cardiovascular Complications</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>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.
To evaluate the association between serum troponin levels during sepsis and 1 year after sepsis cardiovascular events.
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.
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 (
< 0.001). Patients within the elevated troponin tertiles had increased risks of adverse cardiovascular events (adjusted hazard ratio [aHR]
= 1.37; 95% confidence interval [CI], 1.20-1.55; aHR
= 1.44; 95% CI, 1.27-1.63; and aHR
= 1.77; 95% CI, 1.56-2.00).
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers - blood</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Heart Diseases - etiology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Original</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Sepsis</subject><subject>Sepsis - blood</subject><subject>Sepsis - complications</subject><subject>Studies</subject><subject>Survivors - statistics & numerical data</subject><subject>Time Factors</subject><subject>Troponin I - blood</subject><subject>United States</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkV1rFTEQhoMo9kP_gBcS8MabrTOZZD9uhLJULRyoYAXvQjabU1N2kzXZPcV_79atRb0IkzDPvGR4GHuFcIZYynfJ2vFMgECgAkqkq_YJO0ZFqpBNBU_XO1RUSNl8O2InOd8CoKgRnrMjkkB1BXjM9HnO0Xoz-xh45-Y75wK_TnGKwQd-yXfu4IbM-yX5cMO_uCn7zE3o-eeY57w9W5N6Hw8m22UwibdxnAZvf0fmF-zZ3gzZvXyop-zrh4vr9lOxu_p42Z7vCisJ5qIsba1qt8eqR6WkIEmlqQx0aj0dVihdRSj26Bx0putKS13fNKrpsaOSejpl77fcaelG11sX5mQGPSU_mvRTR-P1v53gv-ubeNC1bFAoWAPePgSk-GNxedajz9YNgwkuLlkLRURYKdms6Jv_0Nu4pLCut1IV1Q0AiJUSG2VTzDm5_eNnEPS9P33vT2_-9OZvHXr99xqPI3-E0S9eR5kW</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Garcia, Michael A</creator><creator>Rucci, Justin M</creator><creator>Thai, Khanh K</creator><creator>Lu, Yun</creator><creator>Kipnis, Patricia</creator><creator>Go, Alan S</creator><creator>Desai, Manisha</creator><creator>Bosch, Nicholas A</creator><creator>Martinez, Adriana</creator><creator>Clancy, Heather</creator><creator>Devis, Ycar</creator><creator>Myers, Laura C</creator><creator>Liu, Vincent X</creator><creator>Walkey, Allan J</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6400-6060</orcidid><orcidid>https://orcid.org/0000-0002-2872-3388</orcidid><orcidid>https://orcid.org/0000-0001-6504-2234</orcidid></search><sort><creationdate>20210901</creationdate><title>Association between Troponin I Levels during Sepsis and Postsepsis Cardiovascular Complications</title><author>Garcia, Michael A ; 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however, the association between troponin levels during sepsis and cardiovascular complications after sepsis is unclear.
To evaluate the association between serum troponin levels during sepsis and 1 year after sepsis cardiovascular events.
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.
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 (
< 0.001). Patients within the elevated troponin tertiles had increased risks of adverse cardiovascular events (adjusted hazard ratio [aHR]
= 1.37; 95% confidence interval [CI], 1.20-1.55; aHR
= 1.44; 95% CI, 1.27-1.63; and aHR
= 1.77; 95% CI, 1.56-2.00).
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.</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>34038701</pmid><doi>10.1164/rccm.202103-0613OC</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6400-6060</orcidid><orcidid>https://orcid.org/0000-0002-2872-3388</orcidid><orcidid>https://orcid.org/0000-0001-6504-2234</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | American journal of respiratory and critical care medicine, 2021-09, Vol.204 (5), p.557-565 |
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| source | MEDLINE; American Thoracic Society Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Biomarkers - blood Cardiac arrhythmia Cardiovascular disease Cohort Studies Female Heart Diseases - etiology Humans Male Middle Aged Morbidity Original Retrospective Studies Risk Assessment Risk Factors Sepsis Sepsis - blood Sepsis - complications Studies Survivors - statistics & numerical data Time Factors Troponin I - blood United States |
| title | Association between Troponin I Levels during Sepsis and Postsepsis Cardiovascular Complications |
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