Troponin I testing in dialysis patients presenting to the emergency room: does troponin I predict the 30-day outcome?
BACKGROUND
Troponins are often measured in acutely ill chronic dialysis patients admitted to the emergency room, irrespective of their clinical presentation. The significance of an elevated troponin level in this setting is unclear.


METHODS
We identified all chronic dialysis patients presenting over 1 year to a tertiary care hospital emergency room who also had at least one cardiac troponin I (cTnI) level determination. We evaluated presenting complaints, risk factors for cardiac disease, cTnI levels, and major cardiac events (MCE; occurrence of cardiovascular death, myocardial infarction, de novo heart failure, or coronary revascularization) within 30 days by chart review in 149 patients (79 on hemodialysis, 70 on peritoneal dialysis).


RESULTS
Chest pain was documented in only 29% of the patients. Twenty-two patients (15%) experienced an MCE. The incidence of an MCE was the same in patients with and without chest pain. A cTnI level >0.1 ng/l was a significant predictor of an MCE (odds ratio 15.2, 95% confidence interval CI 5.26, 43.6). The likelihood ratios for MCEs were 0.32 (CI 0.16, 0.63) for a cTnI level <0.1 ng/l, 0.72 (CI 0.09, 5.5) for cTnI concentrations 0.1-0.3 ng/l, 7.8 (CI 4.2, 15) for a cTnI level >0.3, and 11.7 (CI 4.4, 31) for a cTnI concentration >2.0 ng/l.


CONCLUSIONS
In acutely ill chronic dialysis patients presenting to a hospital emergency room, an elevated cTnI level indicates an increased 30-day cardiac risk, regardless of their clinical presentation.
Bueti
Joe
J
Section of Nephrology, St. Boniface General Hospital, Winnipeg, Canada.
Krahn
John
J
Karpinski
Martin
M
Bohm
Clara
C
Fine
Adrian
A
Rigatto
Claudio
C
D000368:Aged; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D016638:Critical Illness; D004636:Emergency Service, Hospital; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000453:epidemiology* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D010530:Peritoneal Dialysis; D011379:Prognosis; D012372:ROC Curve; D006435:Renal Dialysis; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000453:epidemiology; D019210:Troponin I / Q000097:blood*
D019210:Troponin I