Relation of High-Sensitivity Troponin to 1 Year Mortality in 20,000 Consecutive Hospital Patients Undergoing a Blood Test for Any Reason

Hinton, Jonathan; Mariathas, Mark; Gabara, Lavinia; Allan, Rick; Nicholas, Zoe; Kwok, Chun Shing; Ramamoorthy, Sanjay; Calver, Alison; Corbett, Simon; Rawlins, John; Simpson, Iain; Wilkinson, James; Sirohi, Rohit; Mahmoudi, Michael; Martin, Glen P.; Cook, Paul; Mamas, Mamas A.; Curzen, Nick

doi:10.1016/j.amjcard.2021.07.050

Cited by 4 publications

(6 citation statements)

References 18 publications

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“…2,15 Furthermore, in the CHARIOT study, we previously demonstrated that hs-cTnI was independently associated with 1 year mortality in a consecutive cohort of 20,000 patients undergoing a blood test for any reason at the hospital. 14 The current results are consistent with a previous study, which enrolled 1124 (89%) of patients presenting to CC with sepsis, and found that hs-cTnI concentrations were independently associated with 14 day outcome but not after this timeframe, regardless of whether there was any clinical indication for performing the test. 21 The authors of that study suggested that this maybe the result of their cohort of patients having a high burden of acute disease.…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“…1–5 Furthermore, there is an accumulating body of evidence demonstrating that hs-cTn is associated with medium term outcomes in several disease groups. 6–14 Specifically, this research group showed that in a population of 20,000 consecutive patients undergoing a blood test for any reason, inpatient or outpatient, the hs-cTnI concentration was above the ULN in 1 in 20. 4 Furthermore, this concentration was independently associated with 1 year mortality in this population.…”

Section: Introductionmentioning

confidence: 99%

“…4 Furthermore, this concentration was independently associated with 1 year mortality in this population. 14 In critical care (CC) environments, hs-cTn concentrations above the ULN are frequent and have been associated with adverse in hospital outcomes including mortality. [15][16][17][18][19] In our previous work we demonstrated that the hs-cTnI concentration on admission to CC, taken outside the context of routine clinical indications, was independently associated with CC mortality.…”

Section: Introductionmentioning

confidence: 99%

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Is high sensitivity troponin, taken regardless of a clinical indication, associated with 1 year mortality in critical care patients?

Hinton

Augustine

Gabara

et al. 2023

Journal of the Intensive Care Society

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The aim of this study was to assess whether high sensitivity troponin (hs-cTnI) is associated with 1 year mortality in critical care (CC). One year mortality data were obtained from NHS Digital for a consecutive cohort of patients admitted to general CC unit (GCCU) and neuroscience CC unit (NCCU) who had hs-cTnI tests performed throughout their CC admission, regardless of whether the test was clinically indicated. Cox proportional hazards were used to estimate the risk of 1-year mortality. A landmark analysis was undertaken to assess whether any relationship at 1 year was driven by mortality within the first 30 days. A total of 1033 consecutive patients were included. At 1 year 254 (24.6%) patients had died. The admission log(10)hs-cTnI concentration in the entire cohort (HR 1.35 (95% CI 1.05–1.75) p = 0.009 with a bootstrap of 1000 samples) was independently associated with 1 year mortality. On landmark analysis the association with 1 year mortality was driven by 30 day mortality. These results indicate that admission hs-cTnI concentration is independently associated with 1 year mortality in CC and this relationship may be driven by differences in mortality at 30 days.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is high sensitivity troponin, taken regardless of a clinical indication, associated with 1 year mortality in critical care patients?

Hinton

Augustine

Gabara

et al. 2023

Journal of the Intensive Care Society

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“…10 However, such values will be seen in 20% of all hospital patients, including both inpatients and outpatients, due most frequently to either myocardial injury or Type 2, as opposed to Type 1, MI, and the degree of elevation is associated with subsequent medium-term mortality, regardless. 11 Importantly, any detectable troponin, even when below the 99th centile level, is still associated with adverse clinical outcomes. 12 Few studies have investigated mortality risk in a secondary care population of exacerbating COPD patients, stratified by troponin levels, and there is no detailed analysis of data exploring the subsequent management of these patients.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

Kallis,

Kaura,

Samuel

et al. 2023

COPD

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Background: No single biomarker currently risk stratifies chronic obstructive pulmonary disease (COPD) patients at the time of an exacerbation, though previous studies have suggested that patients with elevated troponin at exacerbation have worse outcomes. This study evaluated the relationship between peak cardiac troponin and subsequent major adverse cardiac events (MACE) including allcause mortality and COPD hospital readmission, among patients admitted with COPD exacerbation. Methods: Data from five cross-regional hospitals in England were analysed using the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC) acute coronary syndrome database (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017). People hospitalised with a COPD exacerbation were included, and peak troponin levels were standardised relative to the 99th percentile (upper limit of normal). We used Cox Proportional Hazard models adjusting for age, sex, laboratory results and clinical risk factors, and implemented logarithmic transformation (base-10 logarithm). The primary outcome was risk of MACE within 90 days from peak troponin measurement. Secondary outcome was risk of COPD readmission within 90 days from peak troponin measurement. Results: There were 2487 patients included. Of these, 377 (15.2%) patients had a MACE event and 203 (8.2%) were readmitted within 90 days from peak troponin measurement. A total of 1107 (44.5%) patients had an elevated troponin level. Of 1107 patients with elevated troponin at exacerbation, 256 (22.8%) had a MACE event and 101 (9.0%) a COPD readmission within 90 days from peak troponin measurement. Patients with troponin above the upper limit of normal had a higher risk of MACE (adjusted HR 2.20, 95% CI 1.75-2.77) and COPD hospital readmission (adjusted HR 1.37, 95% CI 1.02-1.83) when compared with patients without elevated troponin. Conclusion: An elevated troponin level at the time of COPD exacerbation may be a useful tool for predicting MACE in COPD patients. The relationship between degree of troponin elevation and risk of future events is complex and requires further investigation.

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Reply to the Letter to the Editor: Response to “Postoperative Myocardial Injury and Outcomes in Liver and Kidney Transplant Patients”

Yang

Ben‐Dor

2023

Cardiovascular Revascularization Medicine

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Relation of High-Sensitivity Troponin to 1 Year Mortality in 20,000 Consecutive Hospital Patients Undergoing a Blood Test for Any Reason

Cited by 4 publications

References 18 publications

Is high sensitivity troponin, taken regardless of a clinical indication, associated with 1 year mortality in critical care patients?

Is high sensitivity troponin, taken regardless of a clinical indication, associated with 1 year mortality in critical care patients?

The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

Reply to the Letter to the Editor: Response to “Postoperative Myocardial Injury and Outcomes in Liver and Kidney Transplant Patients”

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