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Intensive Care Medicine

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01-07-2013 | Systematic Review

Prognostic value of troponins in sepsis: a meta-analysis

Authors: Francis Bessière, Safia Khenifer, Julie Dubourg, Isabelle Durieu, Jean-Christophe Lega

Published in: Intensive Care Medicine | Issue 7/2013

Abstract

Rationale

The role of biomarkers such as troponin in risk stratification of sepsis is still debated. The aim of this meta-analysis is to assess the relation between troponin elevation in sepsis and mortality.

Methods

All observational studies from Embase, Medline and those manually searched up to September 2010 were included. Studies identified were those which reported on patients with a diagnosis of sepsis and if a 2 × 2 table could be constructed based on troponins and death. We pooled the relative risk (RR) and odds-ratio (OR) using the inverse variance method in studies that conducted univariate and multivariable (adjusted) analysis.

Main results

Thirteen studies encompassing 1,227 patients were included. The prevalence of elevated troponin was 61 % ([95 %] CI 58–64 %). Elevated troponin was significantly associated with all-cause mortality (RR 1.91; CI 1.63–2.24), with homogeneity across studies. In adjusted analysis (four studies comprising 791 patients) according to prognostic scores, elevated troponin was associated with an increased risk of death (OR 1.92; CI 1.35–2.74). The area under the ROC curve was 0.68 (CI 0.63–0.71). Pooled sensitivity and specificity were 77 % (CI 61–88) and 47 % (CI 30–64) with heterogeneity across studies. It corresponded to positive and negative likelihood ratios of 1.50 (95 % CI: 1.20–1.90) and 0.49 (CI 0.38–0.64), respectively.

Conclusions

Elevated troponin identifies a subset of patients with sepsis at higher risk of death. Further studies are needed to define the precise role of troponins and their optimal cut-offs.

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Title: Prognostic value of troponins in sepsis: a meta-analysis
Authors: Francis Bessière
Safia Khenifer
Julie Dubourg
Isabelle Durieu
Jean-Christophe Lega
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 7/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-2902-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prognostic value of troponins in sepsis: a meta-analysis

Abstract

Rationale

Methods

Main results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Rationale

Methods

Main results

Conclusions

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