Abstract 10085: Troponin Release is Associated With Mortality and Poor Fluid Resuscitation in Patients With Sepsis

Abstract

Introduction: Septic patients are predisposed to myocardial injury manifested as cardiac troponin release (TnR). Prognostic significance and management implications of TnR in this setting has not been fully elucidated. We aimed to determine the impact of admission TnR and fluid resuscitation on outcomes of patients with sepsis admitted to intensive care units (ICU). Methods: A total of 24,778 patients with sepsis from eICU-CRD (n=11,992), MIMIC-III (n=6,638) and MIMIC-IV (n=6,148) databases were examined for mortality and 1-year survival by multivariable logistic, Cox regression analysis, or Kaplan-Meier survival analysis with overlap weighting adjustment, as well as generalized additive models for fluid resuscitation. Results: TnR on admission was associated with higher in-hospital mortality [adjusted odds ratios (aOR)=1.33; 95% confidence interval (CI)=1.23-1.43; p< 0.001 in unweighted analysis and aOR=1.39; 95% CI=1.29-1.50; p< 0.001 with overlap weighting]. One-year survival was lower in patients with admission TnR (Kaplan-Meier survival analysis; p=0.002). A trend was noted for association between admission TnR and 1-year mortality [aOR=1.16; 95% CI, 0.99-1.37; p = 0.067 in unweighted analysis] while the association was statistically significant after overlap weighting (aOR=1.25; 95% CI=1.06-1.47; p=0.008). We also found that patients with admission TnR were less likely to benefit from more liberal fluid resuscitation. Adequate fluid resuscitation within a range of 70 to 90 ml/kg in the first 24 hours of ICU stay was associated with lower in-hospital mortality in septic patients without TnR but not in those with admission TnR. Conclusions: Admission TnR was significantly associated with higher in-hospital mortality and worse 1-year survival among septic patients. Adequate fluid resuscitation improved in-hospital mortality in septic patients without but not with admission TnR.