title: Myocardial injury in critically ill patients: relation to increased cardiac troponin I and hospital mortality.
abstract: OBJECTIVE
  To examine the relationship between myocardial injury, assessed by cardiac troponin I (cTnI) levels, and outcome in selected critically ill patients without acute coronary syndromes or cardiac dysfunction.
  
  
  METHODS
  Prospective, observational study in the emergency ICU of a university teaching hospital.
  
  
  METHODS
  Over a 6-month period, 217 consecutive patients admitted to the ICU were studied.
  
  
  RESULTS
  cTnI assays were performed in all patients on admission to the ICU. The incidence of myocardial injury, defined by cTnI level > 0.1 ng/mL, was 32% (69 of 217 patients). Overall mortality was 27% (58 of 217 patients). Patients with myocardial injury had a mortality rate of 51%, compared with only 16% mortality for those without myocardial injury (p < 0.001). The hospital mortality rate was highest among older patients (71 +/- 14% vs 58.5 +/- 20%, p < 0.0001) and patients with higher simplified acute physiology scale (SAPS) II score (62 +/- 25% vs 37 +/- 17%, p < 0.0001). Mechanical ventilation was associated with higher in-hospital death (50% vs 31%, for patients who died in the hospital vs those who were discharged alive; p = 0.03). Elevated blood levels of cTnI were found to be independently associated with hospital mortality, regardless of the presence of SAPS II score and mechanical ventilation, in the logistic regression analysis (odds ratio, 2.09; 95% confidence interval, 1.06 to 4.11; p = 0.01).
  
  
  CONCLUSIONS
  This study demonstrates the high frequency of myocardial injury (32%) in critically ill patients without acute coronary syndromes or cardiac dysfunction on admission to ICU. Myocardial injury is an independent determinant of hospital mortality. Assessment of myocardial injury on admission to ICU would make it possible to identify patients at increased risk of death.
authors.affiliation: Emergency Intensive Care Unit, Dijon University Hospital, Dijon, France. jean-pierre.quenot@chu-dijon.fr
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
authors.forename: Gwénaël
authors.initials: G
authors.lastname: Le Teuff
authors.forename: Catherine
authors.initials: C
authors.lastname: Quantin
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Doise
authors.forename: Michal
authors.initials: M
authors.lastname: Abrahamowicz
authors.forename: David
authors.initials: D
authors.lastname: Masson
authors.forename: Bernard
authors.initials: B
authors.lastname: Blettery
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016638:Critical Illness; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006335:Heart Injuries / Q000097:blood* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012044:Regression Analysis; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I