Cardiac Troponin I Levels Are a Risk Factor for Mortality and Multiple Organ Failure in Noncardiac Critically Ill Patients and Have an Additive Effect to the Apache Ii Score in Outcome Prediction

Wu, T J; Yuan, Ang; Chen, Chien-Yuan; Chen, Wen‐Jone; Luh, Kwen‐Tay; Kuo, Sow-Hsong; Lin, Feng-Sheng; Yang, Pan‐Chyr

doi:10.1097/01.shk.0000132484.97424.32

Cited by 91 publications

(84 citation statements)

References 44 publications

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“…These studies found that ALF patients had subclinical myocardial injury and elevated troponin I levels were associated with a significant increase in the morbidity and mortality. In addition, this phenomenon was observed in certain circumstances, such as acute stroke or sepsis (19,20) and was closely related to the prognosis (21). Therefore, it is speculated that the elevated troponin I is due to subclinical myocardial cell injury, such as necrosis or increased membrane permeability; however, troponin I was not measured in the present patient because the measurement of troponin I was not possible in our hospital.…”

Section: Discussioncontrasting

confidence: 40%

Acute Liver Failure Complicated with Severe Heart Failure

et al. 2015

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A young pregnant woman was hospitalized due to hepatitis B virus (HBV)-related acute liver failure (ALF). The cardiac function was normal on admission. However, she developed ALF concurrently with a coma and severe cardiac failure. The patient was diagnosed with severe acute cardiomyopathy due to diffuse hypokinesis of the left ventricle wall on ultrasound cardiography. Following intensive treatment, both the liver and cardiac function dramatically recovered. Although some factors, such as HBV, pregnancy and systemic inflammatory response syndrome, are possible causes of acute cardiomyopathy in the present case, ALF itself may be a risk factor for heart failure.

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Section: Discussioncontrasting

confidence: 40%

Acute Liver Failure Complicated with Severe Heart Failure

et al. 2015

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“…More recently, data is accumulating that cTnI predicts adverse short-term outcomes irrespective of the clinical setting. For example, the cTnI concentration has been measured in intensive care unit (ICU) patients with noncardiac presentations and was found to be a strong predictor of mortality [18, 19]. However, dialysis patients presenting or referred to an ER differ from patients with a normal renal function, from critically ill ICU patients, or from stable dialysis patients in terms of case mix and acuity, and thus generalizing these findings may not be appropriate.…”

Section: Introductionmentioning

confidence: 99%

Troponin I Testing in Dialysis Patients Presenting to the Emergency Room: Does Troponin I Predict the 30-Day Outcome?

et al. 2006

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Background: Troponins are often measured in acutely ill chronic dialysis patients admitted to the emergency room, irrespective of their clinical presentation. The significance of an elevated troponin level in this setting is unclear. Methods: We identified all chronic dialysis patients presenting over 1 year to a tertiary care hospital emergency room who also had at least one cardiac troponin I (cTnI) level determination. We evaluated presenting complaints, risk factors for cardiac disease, cTnI levels, and major cardiac events (MCE; occurrence of cardiovascular death, myocardial infarction, de novo heart failure, or coronary revascularization) within 30 days by chart review in 149 patients (79 on hemodialysis, 70 on peritoneal dialysis). Results: Chest pain was documented in only 29% of the patients. Twenty-two patients (15%) experienced an MCE. The incidence of an MCE was the same in patients with and without chest pain. A cTnI level >0.1 ng/l was a significant predictor of an MCE (odds ratio 15.2, 95% confidence interval CI 5.26, 43.6). The likelihood ratios for MCEs were 0.32 (CI 0.16, 0.63) for a cTnI level <0.1 ng/l, 0.72 (CI 0.09, 5.5) for cTnI concentrations 0.1–0.3 ng/l, 7.8 (CI 4.2, 15) for a cTnI level >0.3, and 11.7 (CI 4.4, 31) for a cTnI concentration >2.0 ng/l. Conclusion: In acutely ill chronic dialysis patients presenting to a hospital emergency room, an elevated cTnI level indicates an increased 30-day cardiac risk, regardless of their clinical presentation.

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“…In a study with 108 patients, Wu et al administered invasive ventilation to 53% of the patients, and total mortality was 39%. 7 In a study by Minkin et al, 62% of patients required mechanical ventilation, and total mortality was 39%. 26 In another study, total mortality was 20%, and 34% in pulmonary diseases.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 Wu et al found that the combination of Tn-I and high Acute Physiology and Chronic Health Evaluation (APACHE II) score was a better risk stratification predictor in ICU patients than was high APACHE II score or elevated Tn-I alone. 7 Therefore, accumulating evidence appears to support the strategy of using multiple biomarkers and assessment instruments in prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…4 Elevated troponin also correlates with mortality and morbidity in intensive care unit (ICU) patients. [5][6][7] The troponin level in these patients is thought to increase secondary to myocardial damage from underlying disease, hypoxia, acidosis, and/or therapies. 8 C-reactive protein (CRP) is secreted by the liver, and plasma CRP rapidly rises in response to inflammation, so it is an important biomarker of systemic inflammation.…”

Section: Introductionmentioning

confidence: 99%

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C-Reactive Protein Alone or Combined With Cardiac Troponin T for Risk Stratification of Respiratory Intensive Care Unit Patients

Özsu¹,

Yılmaz

Yılmaz³

et al. 2011

Respir Care

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BACKGROUND: Mortality is high among patients admitted to intensive care units (ICUs). Several prognostic markers have been described in such patients, but the literature contains no data comparing C-reactive protein (CRP) and cardiac troponin T (cTn-T), nor of a combination of CRP and cTn-T in the same patient group in the ICU. METHODS: This was a retrospective electronic data review of patients who presented to the emergency department for respiratory reasons between December 2007 and December 2009 and in whom CRP and cTn-T levels were measured. Patients with a diagnosis of pulmonary embolism and acute coronary syndrome were excluded. We recorded demographics, chronic diseases, admission diagnosis, Simplified Acute Physiology Score II (SAPS II), ICU stay, and CRP and cTn-T concentrations. RESULTS: We included the records of 158 patients. Mean ICU stay was 9.9 days (range 1-65 d), and mean hospital stay was 14.1 days (range 1-72 d). For predicting mortality, receiver operating characteristic analysis gave a CRP cutoff value of > 10 mg/dL, and a CTn-T cutoff value of > 0.01 ng/mL. For CRP the mortality area under the curve was 0.691 (95% CI 0.608 -0.775), the sensitivity was 65%, and the specificity was 70%. For cTn-T the mortality area under the curve was 0.733 (95% CI 0.655-0.812), the sensitivity was 78%, and the specificity was 56%. Of the patients who died, 65% had CRP > 10 mg/dL and 78% had cTn-T > 0.01 ng/mL. On multivariable regression analysis, CRP > 10 mg/dL was associated with 6.6-fold higher (95% CI 1.7-21.3) ICU mortality. There was no advantage for models that combined CRP and cTn-T. CRP alone was more valuable in predicting ICU mortality than in combination with troponin or SAPS II. CONCLUSIONS: Elevated CRP is an independent early prognostic marker of mortality risk in ICU patients. We suspect that a CRP-based prognosis strategy may be useful.

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Cardiac Troponin I Levels Are a Risk Factor for Mortality and Multiple Organ Failure in Noncardiac Critically Ill Patients and Have an Additive Effect to the Apache Ii Score in Outcome Prediction

Cited by 91 publications

References 44 publications

Acute Liver Failure Complicated with Severe Heart Failure

Acute Liver Failure Complicated with Severe Heart Failure

Troponin I Testing in Dialysis Patients Presenting to the Emergency Room: Does Troponin I Predict the 30-Day Outcome?

C-Reactive Protein Alone or Combined With Cardiac Troponin T for Risk Stratification of Respiratory Intensive Care Unit Patients

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