Elevated cardiac troponin is an independent risk factor for short- and long-term mortality in medical intensive care unit patients.
BACKGROUND
Troponin elevations are common in critically ill patients. Whether they are predictors of mortality independent of the severity of the underlying disease is unclear.


OBJECTIVE
To determine whether troponin elevations predict in-hospital, short-term, and long-term mortality in medical intensive care unit patients independent of the severity of the underlying disease as measured by Acute Physiology and Chronic Health Evaluation III prognostic system.


METHODS
Retrospective study.


METHODS
We examined the Acute Physiology and Chronic Health Evaluation III database and cardiac troponin T levels of medical intensive care unit patients at Mayo Clinic, Rochester, MN.


METHODS
In all, 1,657 patients consecutively admitted to medical intensive care units between August 2000 and December 2001.


METHODS
In-hospital, short-term (30-day), and long-term all-cause mortality.


RESULTS
During hospitalization, 12.5% of patients with a cardiac troponin T < 0.01 microg/L suffered deaths compared with 29.5% among those with cardiac troponin T > or = 0.01 microg/L (p < .001). At 30 days, mortality was 13.7% without and 34.6% with elevations (p < .001). The expected probability of survival at 1-, 2-, and 3-yr follow-up was 43.7%, 33.8%, and 25.7% among patients with cardiac troponin T > or = 0.01 microg/L and 75.3%, 67.6%, and 62.9% in those with cardiac troponin T < 0.01 microg/L, respectively (p < .001). After adjustment for the severity of disease and baseline characteristics, cardiac troponin levels were still associated with in-hospital, short-term, and long-term mortality (p = .006, p = .007, and p = .001, respectively).


CONCLUSIONS
This is a single-site retrospective study that included only patients in whom a troponin level was obtained on admission.


CONCLUSIONS
In medical intensive care unit patients, admission troponin levels are independently associated with short- and long-term mortality, even after adjustment for severity of disease.
Babuin
Luciano
L
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Vasile
Vlad C
VC
Rio Perez
Jose A
JA
Alegria
Jorge R
JR
Chai
High-Seng
HS
Afessa
Bekele
B
Jaffe
Allan S
AS
D018806:APACHE; D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014336:Troponin / Q000097:blood*
D014336:Troponin