Cardiac troponin elevations among critically ill patients.
OBJECTIVE
Elevated levels of cardiac troponins, indicative of the presence of cardiac injury, have been reported in critically ill patients. In this review, the incidence, significance, and clinical relevance of elevated troponin levels among this group of patients will be discussed.


RESULTS
It has been shown that elevated cardiac troponin levels can be present among critically ill septic patients without evidence of myocardial ischemia. Recent studies show that elevated troponin levels are also present in a diverse group of critically ill patients without sepsis or septic shock. In addition, several but not all studies show that the mortality rate of troponin-positive patients is significantly higher compared with troponin-negative patients.


CONCLUSIONS
Elevated troponin levels are not only present in patients suffering from acute coronary syndromes but can also be present in critically ill patients. Even minor elevations are specific for myocardial injury. However, every elevated troponin level in the critically ill patient should not be rigorously diagnosed or treated as a myocardial infarction.
Gunnewiek
Jacqueline M T Klein
JM
Department of Clinical Chemistry, University Medical Centre Nijmegen, The Netherlands. j.kleingunnewiek@akc.umcn.nl
Van Der Hoeven
Johannes G
JG
D016638:Critical Illness; D003937:Diagnosis, Differential; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000175:diagnosis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis; D019209:Troponin C / Q000097:blood*; D019210:Troponin I / Q000097:blood*
D019209:Troponin C; D019210:Troponin I