The role of Troponin I in the prediction of in-hospital death for sepsis or septic shock in Internal Medicine: the SOFA-T score

Background: Sepsis and septic shock (SS) are often managed ininternal medicine departments. SOFA score is used to predict prog-nosis. Troponin I (TnI) has been associated to worse outcomes in SS.Patients and Methods: In the years 2015-2017 we enrolled allthe consecutive patients admitted for SS in two Internal Medicinedepartments with expertise in critical care medicine. For each pa-tient we evaluated, at the admission: (1) SOFA score (2) TnI level(3) sex, age and comorbidities. Main outcome was defined as in-hospital mortality. We chose the best cutoff value for TnI and in-hospital death with ROC curve analysis, adopting Youden index.Then we calculated SOFA-T score adding 1 point to SOFA score if the admission TnI was above the calculated cutoff. Then we com-pared the ROC curves of SOFA and SOFA-T with DeHanley method.Results: 390 subjects (age: 79,6±11,4; males: 49,2%) with 144(36,9%) deaths; median SOFA score was 6 (0-15); mean TnI was1,46 ng/ml (IQR:0,35). TnI predicted significantly the outcome(AUC: 0,61; 95%CI: 0,56-0,66; p=0,0003) with an optimal cutoffof 0,315 ng/ml: positive TnI had an increased risk of death for SS(OR: 2,28; 95% CI: 1,68-3,07; p>0,0001). SOFA score had agood predictive performance (AUC: 0,68; 95%CI: 0,64-0,73;p<0,0001), which was improved in SOFA-T (AUC: 0,70; 95% CI:0,65-0,75; p<0,0001). The difference between SOFA and SOFA-T was significant (AUC difference: 0,15; p=0,001).Discussion: The determination of TnI at the admission and its in-tegration in a validated scoring system as SOFA can improve theprediction of in-hospital death of patients affected by SS.