High‐sensitivity cardiac troponin T 30 days all‐come mortality in patients with acute heart failure. A Propensity Score‐Matching Analysis Based on the EAHFE Registry. TROPICA4 Study

Roset, Álex; Jacob, Javier; Herrero‐Puente, Pablo; Alquézar, Aitor; Martín‐Sánchez, Francisco Javier; Llorens, Pere; Gil, Víctor; Cabello, Irene; Richard, Fernando; Garrido, José Manuel; Gil, Cristina; Llauger, Lluís; Wussler, Desiree; Müeller, Christian; Miró, Òscar

doi:10.1111/eci.13248

Cited by 5 publications

(6 citation statements)

References 23 publications

(28 reference statements)

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“…The c-statistic of troponin alone in predicting in-hospital mortality was higher than those recently reported for 30-day mortality of patients with congestive heart failure, 9 atrial fibrillation or cardiovascular hospitalizations, 10 and syncope for cardiac arrhythmias. 11 The models in these studies [9][10][11] had odds ratios of 2.95, 1.85, and 2.35, respectively, for elevated troponin test values with c-statistics of 0.70, 0.714, and 0.69. These studies did not test the predictive value of models including age and admission laboratory tests without troponin.…”

Section: Discussionmentioning

confidence: 88%

“…Studies that found an increased short-term mortality risk in patients with elevated troponin values did not explore its additive value to that of other risk indicators 9–11 . The present study attempts to determine whether troponin values improve the prediction of in-hospital mortality of older adult patients without suspected ACS above that of a model that includes age and routine admission laboratory tests.…”

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confidence: 93%

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Value of Troponin in Predicting Hospital Mortality of Older Adult Patients without Suspected Acute Coronary Syndromes

Shimoni¹,

Froom²,

Benbassat³

2021

Southern Medical Journal

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Objectives: Some authors have recommended troponin measurement to stratify patient mortality risk, but it is unclear whether troponin values add to age and routine admission laboratory tests in the prediction of in-hospital mortality of older adult patients without suspected acute coronary syndrome (ACS). The aim of our study was to determine whether troponin testing adds significantly to routine admission laboratory testing in predicting in-hospital mortality in patients without a suspected ACS.Methods: In 2018-2019, we reviewed all acutely admitted patients aged 60 years or older to Internal Medicine wards of a regional hospital after excluding those admitted to intensive care or with chest pain. The independent variables were troponin, age, sex, and routine admission laboratory tests. The outcome measure was in-hospital mortality. We compared c-statistics and the observed 10% to 90% risk gradients using logistic regression models for age and routine laboratory testing before and after the addition of troponin. Results:The mortality risk gradient for age and admission laboratory tests was 0.2% to 29.5%. Adding troponin did not increase the gradient significantly (0.2%-34.6%, P = 0.170), and the 95% confidence intervals for the c-statistics overlapped, increasing from 0.845 (0.818-0.876) to 0.866 (0.839-0.892). Conclusions:In older adult patients without suspected ACS, troponin testing did not improve the prediction of hospital mortality above that of a model including age and common admission blood tests. In the absence of suspected ACS, troponin testing is not needed to predict the hospital mortality of older adult patients.

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Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 93%

Value of Troponin in Predicting Hospital Mortality of Older Adult Patients without Suspected Acute Coronary Syndromes

Shimoni¹,

Froom²,

Benbassat³

2021

Southern Medical Journal

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“…Parissis et al identified a ROC optimized hsTnT cut-off of 77 ng/l to predict all-cause mortality with a sensitivity of 62% and specificity of 72% in patients with predominantly reduced LV-EF [ 27 ]. Roset et al found a ROC optimized hsTnT cut-off of 35 ng/l with a sensitivity of 67% and specificity of 56% in a population consisting of both HFrEF and HFpEF [ 28 ]. The difference in cut-offs among these studies may be due to the assessment of different patient cohorts.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of high-sensitive troponin on 30-day mortality in patients with acute heart failure and different classes of left ventricular ejection fraction

et al. 2022

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High-sensitive troponin T (hs-TnT) is increasingly used for prognostication in patients with acute heart failure (AHF). However, uncertainty exists whether hs-TnT shows comparable prognostic performance in patients with heart failure and different classes of left ventricular ejection fraction (LV-EF). The aim of the present study was to assess the prognostic value of hs-TnT for the prediction of 30-day mortality depending on the presence of HF with preserved ejection fraction (HFpEF), HF with mid-range LV-EF (HFmrEF) and HF with reduced LV-EF (HFrEF) in patients with acutely decompensated HF. Patients admitted to our institution due to AHF were retrospectively included. Clinical information was gathered from electronic and paper-based patient charts. Patients with myocardial infarction were excluded. A total of 847 patients were enrolled into the present study. A significant association was found between HF groups and hs-TnT (regression coefficient -0.018 for HFpEF vs. HFmrEF/HFrEF; p = 0.02). The area under the curve (AUC) of hs-TnT for the prediction of 30-mortality was significantly lower in patients with HFpEF (AUC 0.61) than those with HFmrEF (AUC 0.80; p = 0.01) and HFrEF (AUC 0.73; p = 0.04). Hs-TnT was not independently associated with 30-day outcome in the HFpEF group (OR 1.48 [95%-CI 0.89–2.46]; p = 0.13) in contrast to the HFmrEF group (OR 4.53 [95%-CI 1.85–11.1]; p < 0.001) and HFrEF group (OR 2.58 [95%-CI 1.57–4.23]; p < 0.001). Prognostic accuracy of hs-TnT in patients hospitalized for AHF regarding 30-day mortality is significantly lower in patients with HFpEF compared to those with HFmrEF and HFrEF.

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“…Nonetheless, there was a tendency toward an increased risk of mortality in patients with high levels of AG [odds ratio (OR) = 1.42, p = 0.092]. Moreover, according to the evidence derived from the Epidemiology of Acute Heart Failure in Emergency departments (EAHFE) registry ( 17 ), the high-sensitive (hs)-TnT was recently confirmed to be an optimal biomarker in predicting the 30-days all-come mortality in patients with AHF (with the best cutoff point of 35 ng/l). A similar result was also displayed in one recent multicenter-based study, while the cutoff point was hs-TnT ≥ 43 ng/l ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…The ideal risk stratification system would identify a subpopulation of patients with similar pathophysiology and clinical presentation at admission, so that treatment may be tailored for each patient. During the past years, researchers from the different regions have made some attempts to discover the prognostic factors in predicting the short-term (28-30-days) or long-term (1-5 years) mortality and readmission in patients with AHF (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Notably, reviewing the recently published literature, elderly age, multimorbidity, high blood urea nitrogen (BUN), serum creatinine, and hypoalbuminemia were significantly associated with the increased risk of AHF-related mortality (2,3).…”

Section: Introductionmentioning

confidence: 99%

The Value of Admission Serological Indicators for Predicting 28-Day Mortality in Intensive Care Patients With Acute Heart Failure: Construction and Validation of a Nomogram

Wei

Min

et al. 2021

Front. Cardiovasc. Med.

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Background: Acute heart failure (AHF) is a severe clinical syndrome characterized as rapid onset or worsening of symptoms of chronic heart failure (CHF). Risk stratification for patients with AHF in the intensive care unit (ICU) may help clinicians to predict the 28-day mortality risk in this subpopulation and further raise the quality of care.Methods: We retrospectively reviewed and analyzed the demographic characteristics and serological indicators of patients with AHF in the Medical Information Mart for Intensive Care III (MIMIC III) (version 1.4) between June 2001 and October 2012 and our medical center between January 2019 and April 2021. The chi-squared test and the Fisher's exact test were used for comparison of qualitative variables among the AHF death group and non-death group. The clinical variables were selected by using the least absolute shrinkage and selection operator (LASSO) regression. A clinical nomogram for predicting the 28-day mortality was constructed based on the multivariate Cox proportional hazard regression analysis and further validated by the internal and external cohorts.Results: Age > 65 years [hazard ratio (HR) = 2.47], the high Sequential Organ Failure Assessment (SOFA) score (≥3 and ≤8, HR = 2.21; ≥9 and ≤20, HR = 3.29), lactic acid (Lac) (>2 mmol/l, HR = 1.40), bicarbonate (HCO3-) (>28 mmol/l, HR = 1.59), blood urea nitrogen (BUN) (>21 mg/dl, HR = 1.75), albumin (<3.5 g/dl, HR = 2.02), troponin T (TnT) (>0.04 ng/ml, HR = 4.02), and creatine kinase-MB (CK-MB) (>5 ng/ml, HR = 1.64) were the independent risk factors for predicting 28-day mortality of intensive care patients with AHF (p < 0.05). The novel nomogram was developed and validated with a promising C-index of 0.814 (95% CI: 0.754–0.882), 0.820 (95% CI: 0.721–0.897), and 0.828 (95% CI: 0.743–0.917), respectively.Conclusion: This study provides a new insight in early predicting the risk of 28-day mortality in intensive care patients with AHF. The age, the SOFA score, and serum TnT level are the leading three predictors in evaluating the short-term outcome of intensive care patients with AHF. Based on the nomogram, clinicians could better stratify patients with AHF at high risk and make adequate treatment plans.

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High‐sensitivity cardiac troponin T 30 days all‐come mortality in patients with acute heart failure. A Propensity Score‐Matching Analysis Based on the EAHFE Registry. TROPICA4 Study

Cited by 5 publications

References 23 publications

Value of Troponin in Predicting Hospital Mortality of Older Adult Patients without Suspected Acute Coronary Syndromes

Value of Troponin in Predicting Hospital Mortality of Older Adult Patients without Suspected Acute Coronary Syndromes

Prognostic impact of high-sensitive troponin on 30-day mortality in patients with acute heart failure and different classes of left ventricular ejection fraction

The Value of Admission Serological Indicators for Predicting 28-Day Mortality in Intensive Care Patients With Acute Heart Failure: Construction and Validation of a Nomogram

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