Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes Export

@article{citeulike:2081293, abstract = {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. 10.1016/S0735-1097(03)00421-2}, author = {Ammann, Peter and Maggiorini, Marco and Bertel, Osmund and Haenseler, Edgar and Joller-Jemelka, Helen I. and Oechslin, Erwin and Minder, Elisabeth I. and Rickli, Hans and Fehr, Thomas}, citeulike-article-id = {2081293}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/S0735-1097(03)00421-2}, citeulike-linkout-1 = {http://content.onlinejacc.org/cgi/content/abstract/41/11/2004}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/12798573}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=12798573}, comment = {58 critically ill pts (CAD subsequently excluded by stress echo or PM) 32 troponin +ve - mortality \~{}20\%; worse LVEF; ^TNF \& IL6 26 troponin -ve - mortality \~{}5\% }, day = {4}, doi = {10.1016/S0735-1097(03)00421-2}, journal = {J Am Coll Cardiol}, keywords = {diagnosis, mortality, prognosis}, month = {June}, number = {11}, pages = {2004--2009}, posted-at = {2007-12-09 10:23:50}, priority = {2}, title = {Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes}, url = {http://dx.doi.org/10.1016/S0735-1097(03)00421-2}, volume = {41}, year = {2003} }

TY - JOUR ID - citeulike:2081293 L3 - citeulike-article-id:2081293 N2 - 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. 10.1016/S0735-1097(03)00421-2 IS - 11 JF - J Am Coll Cardiol EP - 2009 TI - Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes VL - 41 SP - 2004 KW - diagnosis KW - mortality KW - prognosis N1 - 58 critically ill pts (CAD subsequently excluded by stress echo or PM) 32 troponin +ve - mortality ~20%; worse LVEF; ^TNF & IL6 26 troponin -ve - mortality ~5% AU - Ammann, Peter AU - Maggiorini, Marco AU - Bertel, Osmund AU - Haenseler, Edgar AU - Joller-Jemelka, Helen AU - Oechslin, Erwin AU - Minder, Elisabeth AU - Rickli, Hans AU - Fehr, Thomas PY - 2003/06/04/ UR - http://dx.doi.org/10.1016/S0735-1097(03)00421-2 ER -