The value of admission Troponin I to predict outcomes in suspected infections in elderly patients admitted in Internal Medicine: results from the SOFA-T collaboration, a multi-center study

Tarquinio, Nicola; Viticchi, Giovanna; Zaccone, Vincenzo; Martino, Marianna; Fioranelli, Agnese; Morciano, P.; Moroncini, Gianluca; Pentima, Chiara Di; Martini, Alessandro; Nitti, Cinzia; Salvi, Aldo; Burattini, Maurizio; Falsetti, Lorenzo

doi:10.1007/s11739-020-02610-x

Cited by 9 publications

(6 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…EHMRG contains several items that are currently adopted in the prognostication of AHF and other critical illnesses in internal medicine, such as age, systolic blood pressure, creatinine, electrolyte imbalances, and troponin increase. These markers have a defined prognostic role also in other critical illnesses, often managed outside a cardiologic departments, such as sepsis and septic shock [ 46 , 47 , 48 , 49 , 50 ], pulmonary embolism [ 51 ], and pneumonia [ 52 , 53 , 54 , 55 ]. Thus, the adoption of these items in a predictive score seems more useful for an older, more complex, and less selected population, as the one commonly observed in the ED and in Internal Medicine.…”

Section: Discussionmentioning

confidence: 99%

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

et al. 2022

Self Cite

View full text Add to dashboard Cite

The Emergency Heart Failure Mortality Risk Grade (EHMRG) can predict short-term mortality in patients admitted for acute heart failure (AHF) in the emergency department (ED). This paper aimed to evaluate if TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can improve in-hospital death prediction in patients at moderate-to-high risk, according to EHMRG score classification. From 1 January 2018 to 30 December 2019, we retrospectively enrolled all the consecutive subjects admitted to our Internal Medicine Department for AHF from the ED. We performed bedside echocardiography within the first 24 h of admission. We evaluated EHMRG and NYHA in the ED, days of admission in Internal Medicine, and in-hospital mortality. We assessed cutoffs with ROC curve analysis and survival with Kaplan–Meier and Cox regression. We obtained a cohort of 439 subjects; 10.3% underwent in-hospital death. Patients with normal TAPSE/PASp in EHMRG Classes 4, 5a, and 5b had higher survival rates (100%, 100%, and 94.3%, respectively), while subjects with pathologic TAPSE/PASp had lower survival rates (81.8%, 78.3%, and 43.4%, respectively) (p < 0.0001, log-rank test). TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can further stratify the risk of in-hospital death evaluated by EHMRG.

show abstract

Section: Discussionmentioning

confidence: 99%

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…In this study, an evaluation by cardiologists was associated with reduced mortality in stable patients with cTn elevation at hospitalization for a noncardiac reason. An association between high-intensity medical staffing and reduced mortality was previously demonstrated, but mostly in the critical care setting [ 6 , 16 , 25 , 26 , 27 ]. Explanations for this association include full attention to patient status and the ability to recognize and manage events promptly [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, one-year mortality and 30-day mortality were lower in the cardiologist evaluation group compared to the no cardiologist evaluation group. Generally, ischemic injury is assumed to be an acute event, and hence relevant studies are mostly focused on short-term mortality, rather than long-term outcomes [ 6 , 14 , 27 ]. So, our result for the long-term follow-up suggested the possibility that improved mortality may not be fully dependent on myocardial injuries that are caused by ischemia.…”

Section: Discussionmentioning

confidence: 99%

Association between Cardiologist Consultation and Mortality of Stable Patients with Elevated Cardiac Troponin at Admission

Park

Lee

et al. 2021

Diagnostics

View full text Add to dashboard Cite

Elevated cardiac troponin (cTn) showed associations with mortality even in stable patients, but management has not been established. We aimed to investigate whether consultation to cardiologists could reduce mortality of stable patients with cTn elevation at admission. We identified 1329 patients with elevated cTn level at hospitalization from outpatient clinic to any department other than cardiology or cardiac surgery between April 2010 and December 2018. The patients were divided into two groups according to cardiologist consultation at admission. For primary outcome, mortality during one year was compared in the crude and propensity-score-matched populations. In 1329 patients, 397 (29.9%) were consulted to cardiologists and 932 (70.1%) were not. Mortality during the first year was significantly lower in patients consulted to cardiologists compared with those who were not (9.8% vs. 14.2%; hazard ratio (HR), 0.50; 95% confidence interval (CI), 0.35–0.72; p < 0.001). After propensity-score matching, 324 patients were in the cardiologist consultation group and 560 patients were in the no cardiologist consultation group. One-year mortality was consistently lower in the cardiologist consultation group (10.5% vs. 14.6%; HR, 0.58; 95% CI, 0.39–0.86; p = 0.01). Cardiologist consultation may be associated with lower mortality in stable patients with cTn elevation at admission. Further studies are needed to identify effective management strategies for stable patients with elevated cTn.

show abstract

“…In a study published in 2021, it was shown that patients with Troponin I (aTnI) value above 0.31 ng/ml on admission are exposed to a high risk for in-hospital death (OR: 1.834; p: 0.009), and high SOFA (p=0.01) [45].…”

Section: Diagnosismentioning

confidence: 99%

Geriatric Sepsis in the COVID-19 Era: Challenges in Diagnosis and Management

Karcıoglu¹,

Yilmaz²,

Kilic³

et al. 2022

Int J Pharm Res Allied Sci

View full text Add to dashboard Cite

The elderly or geriatric patients represent a significant portion of emergency department (ED) admissions. Factors affecting poor outcome in these patients suspected or diagnosed with sepsis include shock, hyperlactatemia, and organ failure. Atypical presentations should be emphasized in the training of triage and ED personnel due to difficulties and pitfalls in diagnostic processes for sepsis. The vital organ functions of the elderly, who are among the highest risk groups in the management of sepsis, may deteriorate rapidly with very few precursors, and aggressive methods should be used rapidly when necessary. Interactions of drug doses in the elderly, problems in excretion and differences in metabolism should be considered in treatment regimens. Healthcare workers should try to eliminate colonization risks such as vascular catheterization, unnecessary vascular access and urinary catheters should be removed. In the long term after recovery from sepsis, heart failure, peripheral vascular disease, dementia, and diabetes are the most common entities recorded in the literature. This review was intended to provide an overview of the overall management and give some practical tips for this fragile group of patients in the post-pandemic era.

show abstract

The value of admission Troponin I to predict outcomes in suspected infections in elderly patients admitted in Internal Medicine: results from the SOFA-T collaboration, a multi-center study

Cited by 9 publications

References 38 publications

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

Association between Cardiologist Consultation and Mortality of Stable Patients with Elevated Cardiac Troponin at Admission

Geriatric Sepsis in the COVID-19 Era: Challenges in Diagnosis and Management

Contact Info

Product

Resources

About