Prognostic Value of High-sensitivity Troponin I in Patients with Septic Shock: A Prospective Observational Study

Septic shock is a leading cause of mortality in intensive care units (ICUs). Despite recent advances in the management of septic shock, mortality rates have remained remarkably high, ranging from 30 to 50%. Septic myocardial dysfunction is usually defined as global (systolic and diastolic) but reversible biventricular dysfunction. An incidence ranging from 20 to 60% has been reported in the first 3 days after the onset of septic shock. 3 Ventricular function generally returns to normal within 7-10 days. The pathophysiology of this dysfunction is complex and not completely understood. It involves, in addition to circulatory abnormalities, alterations in coronary blood flow, circulating depressant factors, microvascular dysfunction, abnormalities of beta-adrenergic signal transduction 5 , apoptotic phenomena and calcium dysregulation. Cardiac troponins are specific biomarkers of myocardial cell injury and their role for risk stratification in acute coronary syndromes is well established. The role of troponin in risk stratification of sepsis is still debated. 8,9 A new generation of highly sensitive troponin assays has recently been developed that allow the detection of concentrations 10 times lower than those measureable with conventional assays. The aim of this study was to determine the association between high-sensitivity cardiac troponin I (hs-cTnI) elevation and 28-day mortality in patients with septic shock.