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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

View larger version (27K): [in a new window]   Figure 1 Kaplan-Meier survival analysis of troponin-positive and -negative patients. (A) The overall 30-day mortality was significantly higher in troponin-positive (n = 32) than in troponin-negative (n = 26) patients (p = 0.018). (B) When subgroups of patients with volume-refractory shock needing catecholamine therapy (n = 24) and patients without shock (n = 34) were analyzed separately, a significant difference in mortality was found in the subgroup without shock only (p = 0.03). ns = not significant.

View larger version (21K): [in a new window]   Figure 2 Relationship between left ventricular ejection fraction (LVEF) and peak cardiac troponin I (cTnI) level. A significantly lower LVEF was found in troponin-positive versus -negative patients (r = 0.44, p = 0.0006). All patients with LVEF <45% (left of thin vertical line) had sepsis or septic shock, and 11 of 13 were troponin-positive. The normal cutoff level for cTnI is indicated at 0.1 µg/l by a bold horizontal line.