Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes

We sought to assess the mechanism and prognostic value of elevated troponins in patients without acute coronary syndromes (ACS). Cardiac troponins are used as specific markers for the diagnosis of ACS. Recent studies reported a considerable number of critically ill patients without ACS as being trop...

Full description

Saved in:
Bibliographic Details
Published in:Journal of the American College of Cardiology 2003-06, Vol.41 (11), p.2004-2009
Main Authors: Ammann, Peter, Maggiorini, Marco, Bertel, Osmund, Haenseler, Edgar, Joller-Jemelka, Helen I, Oechslin, Erwin, Minder, Elisabeth I, Rickli, Hans, Fehr, Thomas
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Acute Disease
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Biomarkers - blood
Blood
Cardiology
Cardiovascular disease
Coronary Angiography
Coronary Disease - blood
Coronary Disease - epidemiology
Critical Illness - mortality
Cytokines
Cytokines - metabolism
Echocardiography, Stress
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Enzymes
Female
Gram-Negative Bacterial Infections - blood
Gram-Negative Bacterial Infections - mortality
Gram-Positive Bacterial Infections - blood
Gram-Positive Bacterial Infections - mortality
Heart attacks
Heart surgery
Humans
Intensive care
Intensive care medicine
Ischemia
Kinases
Male
Mathematical models
Medical sciences
Middle Aged
Mortality
Neutrophils - physiology
Proteins
Risk Factors
Sepsis
Shock, Septic - blood
Shock, Septic - mortality
Stroke Volume - physiology
Studies
Survival Analysis
Syndrome
Time Factors
Troponin - blood
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We sought to assess the mechanism and prognostic value of elevated troponins in patients without acute coronary syndromes (ACS). Cardiac troponins are used as specific markers for the diagnosis of ACS. Recent studies reported a considerable number of critically ill patients without ACS as being troponin-positive, especially patients with sepsis, pulmonary embolism, renal failure, and stroke. We analyzed 58 consecutive, critically ill patients admitted for reasons other than ACS, according to their troponin status. Thirty-day mortality, left ventricular ejection fraction (LVEF), and a panel of inflammatory cytokines were compared between troponin-positive and troponin-negative patients. Relevant coronary artery disease was excluded either by stress echocardiography or autopsy. Of the 58 critically ill patients, 32 (55%) without evidence of ACS were troponin-positive. Positive troponin levels were associated with higher mortality (22.4% vs. 5.2%, p < 0.018) and a lower LVEF (p = 0.0006). Troponin-positive patients had significantly higher median levels of tumor necrosis factor (TNF)-alpha, its soluble receptor, and interleukin (IL)-6. A subgroup of 10 aplastic patients was troponin-negative at study entry. Three became troponin-positive during leukocyte recovery and subsequently died, whereas all the others stayed troponin-negative and survived. Flow-limiting coronary artery disease was not demonstrable at autopsy or stress echocardiography in 72% of troponin-positive patients. Elevated troponin is a mortality risk factor for medical intensive care patients admitted for reasons other than ACS. It is associated with decreased left ventricular function and higher levels of TNF-alpha and IL-6.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(03)00421-2