Postoperative troponin-T predicts prolonged intensive care unit length of stay following cardiac surgery.
OBJECTIVE
To evaluate the use of postoperative cardiac troponin T (cTnT) for the prediction of prolonged intensive care unit length of stay following cardiac surgery.


METHODS
Prospective, single-center, observational cohort study of patients following cardiac surgical procedures. The enrollment period was from October through December 2000. Patients were enrolled on admission to the intensive care unit and followed until hospital discharge.


METHODS
The cardiac surgical intensive care unit of the Massachusetts General Hospital.


METHODS
A total of 222 consecutive patients were enrolled.


METHODS
None.


RESULTS
Perioperative clinical factors and serum concentrations of cTnT measured every 8 hrs after surgery were recorded. These clinical factors and the results of serum cTnT measurement were correlated with the need for prolonged intensive care unit length of stay (defined as >24 hrs). Univariable analysis identified factors predictive of prolonged intensive care unit length of stay. Stepwise logistic regression identified independent predictors of prolonged intensive care unit length of stay. Multiple linear regression was used to explore the direct relationship between cTnT concentrations at several postoperative time points and intensive care unit length of stay. At each time point assessed, cTnT concentrations from patients requiring a prolonged intensive care unit length of stay were significantly higher (all p <.001) than in those individuals with normal length of stay. In contrast, creatine kinase isoenzymes were not significantly different between patients with normal or prolonged intensive care unit length of stay. Multivariable analysis demonstrated that an immediate postoperative cTnT concentration > or =1.58 ng/mL was the strongest predictor of a prolonged intensive care unit length of stay (odds ratio, 5.6; 95% confidence interval, 2.9-10.8). Multiple linear regression analysis revealed that intensive care unit length of stay increased by 0.32 days with each incremental 1.0 ng/mL increase in cTnT measured at 18-24 hrs postprocedure.


CONCLUSIONS
Elevated postoperative cTnT concentrations can prospectively identify patients requiring prolonged intensive care unit length of stay after cardiac surgery.
Baggish
Aaron L
AL
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
MacGillivray
Thomas E
TE
Hoffman
William
W
Newell
John B
JB
Lewandrowski
Kent B
KB
Lee-Lewandrowski
Elizabeth
E
Anwaruddin
Saif
S
Siebert
Uwe
U
Januzzi
James L
JL
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001900:Boston; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T