Calprotectin plus troponin T change flags sepsis heart injury, study finds

Calprotectin, an inflammatory protein measured in blood, together with the change in cardiac troponin T over 48 hours, may help identify sepsis-induced myocardial injury early, according to a retrospective observational study published in BMC Cardiovascular Disorders. The researchers report that both markers were independently associated with the condition, although adding calprotectin to troponin change alone yielded only a modest numerical gain in diagnostic discrimination.

Calprotectin levels were significantly higher in patients with sepsis-induced myocardial injury than in those without the condition, at 57.59 ± 15.91 versus 47.89 ± 12.00 ng/mL, a difference the authors report as statistically significant with p < 0.001. In multivariable logistic regression analysis, calprotectin showed an odds ratio of 1.058 (95% confidence interval: 1.023–1.094; p = 0.001), and the absolute change in troponin T showed an odds ratio of 1.021 (95% confidence interval: 1.010–1.033; p < 0.001), meaning both were independently associated with the injury after adjustment for other factors in the model.

The area under the curve was 0.708 for calprotectin alone and 0.829 for the change in troponin T alone. When the two markers were combined, the area under the curve reached 0.832, which the authors describe as only a modest numerical increase in discrimination compared with troponin change alone. This suggests that the dynamic troponin measurement carries most of the diagnostic information in this cohort, with calprotectin contributing a small additional increment.

In a separate analysis aimed at differentiating sepsis-induced myocardial injury from coronary heart disease-related heart failure, calprotectin, troponin T change, age, and diabetes mellitus were independently associated with group classification in the multivariable model. The combined calprotectin and troponin ROC model yielded an area under the curve of 0.809 for this distinction, indicating moderate discriminatory ability in separating the two conditions within this patient group.

The authors conclude that calprotectin and dynamic changes in troponin T may provide complementary information for identifying sepsis-induced myocardial injury, but they emphasize that the incremental improvement in discrimination achieved by adding calprotectin to troponin change alone was modest in this cohort. They explicitly state that these findings should be considered exploratory and require validation in larger, independent cohorts before any clinical implementation.

Several limitations follow from the study design. The modest sample size of 207 patients, the single-center setting, and the exploratory nature of the analysis all limit the generalizability of the reported odds ratios and area-under-the-curve values. The authors note that larger, independent cohorts are needed before the combined marker approach could be considered for routine use.

Within these constraints, the study adds to the evidence that inflammatory markers such as calprotectin, which reflects neutrophil and monocyte activation, may carry information relevant to cardiac involvement in sepsis beyond what serial troponin measurements provide. The reported odds ratios indicate that each unit increase in calprotectin and in the absolute troponin T change was associated with higher odds of the injury in this cohort, though the magnitude of these associations and their diagnostic added value remain modest. Further research in independent populations will be needed to determine whether the combined approach offers meaningful clinical benefit over existing troponin-based monitoring.

Subject of Research: Diagnostic performance of calprotectin combined with dynamic cardiac troponin T changes for identifying sepsis-induced myocardial injury in ICU patients

Article Title: Diagnostic utility of calprotectin combined with dynamic changes in cardiac troponin t in sepsis-induced myocardial injury

Article References: Zang, H.-L., Shang, Y.-J., Guo, H., Guo, H., Zhao, Q., Li, X.-R., Qin, J., & Du, Q.-S. (2026). Diagnostic utility of calprotectin combined with dynamic changes in cardiac troponin t in sepsis-induced myocardial injury. BMC Cardiovascular Disorders. https://doi.org/10.1186/s12872-026-06754-0

Image Credits: AI Generated

DOI: 10.1186/s12872-026-06754-0

Keywords: sepsis-induced myocardial injury, calprotectin, cardiac troponin T, diagnostic utility, retrospective observational study, ROC curve analysis, multivariable logistic regression, echocardiography, intensive care unit, BMC Cardiovascular Disorders, Diagnostic, utility