Abstract 15990: Incidence and Outcomes of Elevated Troponins in Patients With Rhabdomyolysis

Abstract

Introduction: The relationship between rhabdomyolysis and elevated troponins has not been clearly established. Literature has been limited to case reports and small single center studies. However, there are no studies that evaluated the incidence and outcomes of troponin elevation in patients with rhabdomyolysis. Methods: Patients of 18 years and older with rhabdomyolysis were selected from the Healthcare Cost and Utilization Project National Inpatient Sample, 2005 to 2014. Patients with elevated troponins were identified. Information on demographics, co-morbidities and interventions (percutaneous coronary intervention (PCI) vs. no PCI) were extracted. The two main outcomes were mortality and hospital cost. Differences in characteristics and outcomes of patients with elevated troponins and those without elevated troponins were evaluated using descriptive analyses and multivariate regression models. Results: A total of 404,369 rhabdomyolysis participants were identified with 24,986 (6.18%) having elevated troponins. Of these, only 133 (0.03%) patients underwent PCI. Compared to the patients without elevated troponins, patients with elevated troponins were older (69y vs. 61y; P <0.001), and the majority were white (73.9% vs. 66.0%; P <0.001). In-hospital mortality in patients with elevated troponins was 20.5% compared to 5.4% in patients without elevated troponins ( P <0.001) resulting in an adjusted odds ratio of 4.05 (95% CI: 3.90 - 4.20). Compared to the patients without elevated troponins, the median hospital cost in patients with elevated troponins was $17,308 vs. $8,434 ( P <0.001) resulting in an adjusted mean difference of $9,547 (95% CI: $9,189 - $9,904). Conclusions: Our analysis showed that 6.1% of rhabdomyolysis patients have elevated troponins. Of these, very few patients underwent PCI, suggesting myocardial injury in these patients. Patients with elevated troponins had higher in-hospital mortality and increased cost of hospitalization. Due to the bad prognosis associated with elevated troponins, there is need for further evaluation for underlying coronary artery disease in patients with myocardial injury.

Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing

“…Studies on the risks of elevated conventional Tn in rhabdomyolysis show mixed results regarding the increased risk of mortality, although a large study of 404,369 patients with rhabdomyolysis showed an increased risk of mortality and a higher hospital cost in patients with elevated Tn [ 219 , 222 ]. Treatment with fluid resuscitation has been found to reduce measured serum Tn levels to baseline, but patients at risk for CAD should undergo evaluation after the resolution of rhabdomyolysis [ 155 , 221 ].…”