Background: Studies largely performed in Europe suggest that elevated cardiac troponin levels in patients hospitalized with criteria met for sepsis are associated with increased morbidity and mortality. These studies were predominantly done in intensive care units or as a subgroup of other research studies. This study aims to determine if there is an association between elevated high-sensitivity troponin T (hs-tT) levels and increased mortality and morbidity in a large urban hospital patient population with pneumonia who met criteria for sepsis.
Methods: This is a retrospective study of patients admitted to an urban ED from 12/13/2017 to 07/10/2018 with a diagnosis of pneumonia who had a hs-tT (Roche Gen 5 troponin T) ordered in the ED. Multivariate analysis was done to determine patient factors associated with a peak hs-tT >99th percentile (≥19 ng/mL). Univariate analysis was done to determine association with a peak hs-tT >99th percentile or myocardial infarction threshold (≥52 ng/mL) and ED recidivism or death within 30 days.
Results: A total of 178 patients (52.8% male) with a median age of 57 had a hs-tT level during this time period. There were 63 patients with hs-tT levels above the 99th percentile (21 were above the myocardial infarction threshold), 49 patients who returned to the ED within 30 days and 3 deaths. After adjusting for factors associated with an elevated hs-tT (age, serum creatinine, congestive heart failure (CHF) and cardiac risk factors) only age, history of CHF and serum creatinine were independently associated with an elevated hs-tT. A value of hs-tT >99th percentile or above the myocardial infarction threshold was not associated with ED recidivism (RR 1.05, 95% CI 0.7-1.7) or death (RR 1.34, 95% CI 0.7-2.5).
Conclusion: In an urban ED, an elevated hs-tT was not associated with 30-day ED recidivism or death in patients admitted with sepsis secondary to pneumonia who had hs-tT ordered as part of clinical care. Factors associated with an elevated hs-tT include age, history of CHF and history of end-stage renal disease.