Elevation of Troponin-I in Sepsis & Septic Shock

The study of Elevation of troponin I in sepsis and septic shock on 40 patients was conducted in KIMS Hospital and research centre ICU, Bangalore during the period from November 2012 to May 2014. Cases were selected according to the sepsis criteria and enrolled for study. Objective: To determine the association of elevated cTnI levels in patients with sepsis and septic shock. Methodology & Results: Data were analyzed between sepsis and septic shock groups and between troponin I positive and negative groups. The average age groups in sepsis were 47.7 and in septic shock were 53.8. Males were mostly affected in both sepsis and septic shock groups (67%) than females (32.5%). ECG was normal in majority of patients and sinus tachycardia seen in majority of patients with septic shock. ECHO showed normal in all patients expect in two patients in septic shock group who had global hypokinesia. Majority of Patients were diagnosed with Pneumonia (45%). Troponin I showed positive in 29(72.5%) patients and normal in 11(27.5%) patients which was statistically significant. Troponin I showed positive, more in septic shock group 19(95%) as compared to sepsis group 10(50%). In majority of cTnI positive patients CK (18(62.0%) and CK-MB 17(58.6%) was elevated which is not significant. Troponin I positive patients requiring ventillatory support (82.7%), dialysis (24.1%), ionotropic support (65.5%) were more than patients in negative group requiring ventillatory support (45%), dialysis 2(18.1%) and ionotropic support(9%). In troponin I positive group from all cultures gram positive isolated was 11(63.6%) and gram negative was 28(96.5%). In troponin I negative group from all culture gram positive isolated were 7(37.9%) and gram negative were 5(45.4%). Isolation of gram positive and gram negative organisms in troponin I positive group was 39(134.4%) compared to negative group which is 12(109.09%). Isolation of fungi and virus (H1N1) in troponin I positive group showed 6(20.6%) compared to negative group which is 1(90.9%) showing statistically significant. Conclusion: Elevation of troponin I in sepsis and septic shock indicates inflammatory and toxic damage to heart apart from ischemic damage caused by myocardial Infarction.