CLINICAL RESEARCH: BIOMARKERS IN HEART DISEASE
Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes
Peter Ammann, MD*,*,1,
Marco Maggiorini, MD ,
Osmund Bertel, MD*,
Edgar Haenseler, MD ,
Helen I. Joller-Jemelka, MD||,
Erwin Oechslin, MD¶,
Elisabeth I. Minder, MD ,
Hans Rickli, MD¶ and
Thomas Fehr, MD
* Division of Cardiology, Triemli Hospital, Zurich, Switzerland
Central Laboratory, Triemli Hospital, Zurich, Switzerland
Intensive Care Unit of the Department of Internal Medicine, Zurich, Switzerland
Institute of Clinical Chemistry, Zurich, Switzerland
|| Division of Clinical Immunology, University Hospital, Zurich, Switzerland
¶ Division of Cardiology, University Hospital, Zurich, Switzerland
Manuscript received November 19, 2002;
revised manuscript received January 26, 2003,
accepted February 25, 2003.
* Reprint requests and correspondence: Dr. Peter Ammann, Division of Cardiology, Department of Internal Medicine, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland.
peter.ammann{at}kssg.ch
OBJECTIVES: We sought to assess the mechanism and prognostic value of elevated troponins in patients without acute coronary syndromes (ACS).
BACKGROUND: Cardiac troponins are used as specific markers for the diagnosis of ACS. Recent studies reported a considerable number of critically ill patients without ACS as being troponin-positive, especially patients with sepsis, pulmonary embolism, renal failure, and stroke.
METHODS: We analyzed 58 consecutive, critically ill patients admitted for reasons other than ACS, according to their troponin status. Thirty-day mortality, left ventricular ejection fraction (LVEF), and a panel of inflammatory cytokines were compared between troponin-positive and troponin-negative patients. Relevant coronary artery disease was excluded either by stress echocardiography or autopsy.
RESULTS: Of the 58 critically ill patients, 32 (55%) without evidence of ACS were troponin-positive. Positive troponin levels were associated with higher mortality (22.4% vs. 5.2%, p < 0.018) and a lower LVEF (p = 0.0006). Troponin-positive patients had significantly higher median levels of tumor necrosis factor (TNF)-alpha, its soluble receptor, and interleukin (IL)-6. A subgroup of 10 aplastic patients was troponin-negative at study entry. Three became troponin-positive during leukocyte recovery and subsequently died, whereas all the others stayed troponin-negative and survived. Flow-limiting coronary artery disease was not demonstrable at autopsy or stress echocardiography in 72% of troponin-positive patients.
CONCLUSIONS: Elevated troponin is a mortality risk factor for medical intensive care patients admitted for reasons other than ACS. It is associated with decreased left ventricular function and higher levels of TNF-alpha and IL-6.
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Abbreviations and Acronyms
| | ACS | | acute coronary syndromes | | cTnI | | cardiac troponin I | | cTnT | | cardiac troponin T | | IL | | interleukin | | LVEF | | left ventricular ejection fraction | | SAPS | | Simplified Acute Physiology Score | | SIRS | | systemic inflammatory response syndrome | | TNF | | tumor necrosis factor |
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