Hs-Troponin I, as a Predictive Marker of Cardiovascular Instability in Sepsis and Septic Shock–A Prospective Observational Study

INTRODUCTION: Sepsis and septic shock are leading causes of mortality in intensive care units (ICUs), often complicated by myocardial dysfunction. High-sensitivity troponin I (hs-TnI) has emerged as a sensitive biomarker for myocardial injury, but its role in predicting cardiovascular instability and mortality in sepsis requires further investigation. OBJECTIVE: To evaluate hs-TnI as a predictive marker for cardiovascular instability and 28-day mortality in patients with sepsis and septic shock. MATERIALS AND METHODS: This prospective observational study enrolled 40 adult patients with sepsis/septic shock at Medicover Hospitals, Critical Care Unit. Hs-TnI levels were measured at admission, 24 hours, and at onset of cardiovascular instability. Statistical analysis included Mann-Whitney U test, chi-square analysis, ROC curve analysis, and multivariate logistic regression for mortality prediction. RESULTS: Among 40 patients, median hs-TnI levels increased progressively: admission 39.0 ng/L (IQR: 15.5-63.0), 24 hours 85.0 ng/L (IQR: 17.5-140.3), and at the onset of cardiovascular instability 178.0 ng/L (IQR: 86.5-402.0). Hospital survivors had significantly lower hs-TnI at all time points compared to non-survivors (p < 0.001). ROC curve analysis showed hs-TnI at 24 hours had excellent discriminatory power for 28-day mortality (AUC = 0.846). Multivariate analysis identified hs-TnI at 24 hours (OR: 1.012, 95% CI: 1.003-1.021, p = 0.009) as an independent predictor of mortality. CONCLUSION: High-sensitivity troponin I, particularly when measured at 24 hours, is a valuable independent predictor of cardiovascular instability and mortality in sepsis and septic shock. Serial measurement provides important prognostic information supporting its incorporation into sepsis management protocols.