Activated protein C improves survival in severe sepsis patients with elevated troponin

Objective: Multiple studies in sepsis have demonstrated that elevated troponin is associated with poor outcome. The elevated troponin in this situation is thought to be secondary to microthrombi. We hypothesized that recombinant human activated protein C (APC) treatment would improve outcomes in severe sepsis patients who have elevated troponin. Methods: Patients with severe sepsis by consensus criteria in a university ICU were divided into a troponin elevated group (cTnI(+)) and a normal troponin (cTnI(-)) group. Outcome was compared using Fisher's exact test. APACHE II and MODS were calculated by standard methods. Patients: We identified 105 patients with severe sepsis and troponin measured, of which 48 (46%) were in the cTnI+ group. The two groups were similar in terms of age and other comorbid conditions. Results: APACHE II (28 +/- 8 vs. 25 +/- 8) was slightly higher and MODS (11 +/- 4 vs. 9 +/- 3) was significantly higher in the cTnI(+) group. Mortality was 52% (25/48) in cTnI(+) group and 30% (17/57) in cTnI(+) group. Mortality was 30% in cTnI(+) patients treated with APC and 72% in untreated cTnI(+) patients. Conclusions: Patients with severe sepsis who have elevated troponin have increased mortality. In patients with severe sepsis who have elevated troponin, treatment with APC improves outcome. Further study is needed to determine whether troponin can serve as a simple, readily available marker to identify which patients with severe sepsis will benefit from APC.