Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes.
OBJECTIVE
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.
Ammann
Peter
P
Division of Cardiology, Triemli Hospital, Zurich, Switzerland. peter.ammann@kssg.ch
Maggiorini
Marco
M
Bertel
Osmund
O
Haenseler
Edgar
E
Joller-Jemelka
Helen I
HI
Oechslin
Erwin
E
Minder
Elisabeth I
EI
Rickli
Hans
H
Fehr
Thomas
T
D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology*; D016638:Critical Illness / Q000401:mortality; D016207:Cytokines / Q000378:metabolism; D025401:Echocardiography, Stress; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000502:physiology; D012307:Risk Factors; D012772:Shock, Septic / Q000097:blood / Q000401:mortality; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013577:Syndrome; D013997:Time Factors; D014336:Troponin / Q000097:blood*
D015415:Biomarkers; D016207:Cytokines; D014336:Troponin