Abstract 14760: Troponin Leak in Sepsis: Does it Correlate With Hemodynamics?

Abstract

Introduction: Although several studies have demonstrated that elevated troponin predicts mortality in septic patients, data concerning the independent risk factors predisposing to higher chance of troponin leak are conflicting. Hypothesis: In this study we aim to identify predictors of troponinemia and lactatemia in the setting of sepsis and more specifically to clarify how hemodynamics affect these biomarkers. Methods: This is a retrospective cohort study on patients admitted to the intensive care units with severe sepsis. A total of 354 patients were included. Elevated admission troponin-T and lactate were defined as ≥0.01ng/mL and 2.5mmol/L respectively. Modified shock index defined as heart rate/mean arterial blood pressure (MSI) was used as a surrogate of hemodynamic instability. Linear regression models where generated to examine multi variate associations and Cox regression models were used for mortality outcomes. Analysis was done using STATA I/C 16.1. Results: The only independent predictor of elevated troponin in the setting of septic shock was pre-existing coronary artery disease (Coef.= 6 [1.9 - 10] p = 0.001). Troponin was not associated with mean arterial pressure (MAP) nor Modified Shock Index (Heart rate/MAP). On the other hand, elevation of lactate was significantly associated with Modified Shock index (Coef.=1.7 [CI 0.4 - 3] p= 0.001) and history of Diabetes (Coef.=1.2[0.04-2.3] p= 0.04). In a Cox regression modeling assessing for predictors of mortality in septic shock, lactate levels were strongly associated with death (OR= 1.17 [1.12-1.2] p= 0.0001) followed by male sex (OR= 1.8 [1.02-3] p=0.04) and Modified Shock Index (OR=1.5 [1.23-3.2] p=0.03) but troponin leak failed to show any correlation with mortality. Conclusions: Troponin leak is associated only with pre-existing CAD, not associated with hemodynamics and does not predict mortality.