Long-term prognostic significance of elevated cardiac troponin levels in critically ill patients with acute gastrointestinal bleeding.
BACKGROUND
Elevations in troponin level have prognostic importance in critically ill patients, including those with gastrointestinal (GI) bleeding. However, there are no data addressing the independent association of troponin levels and mortality, adjusted for the severity of the underlying disease, in patients with GI bleeding.


OBJECTIVE
This study was designed to determine whether troponin T elevations are independently associated with in-hospital, short-term (30 days), and long-term mortality in medical intensive care unit patients with GI bleeding after adjusting for the severity of disease measured by the Acute Physiology, Age, and Chronic Health Evaluation score prognostic system.


METHODS
Retrospective study.


METHODS
We examined the Acute Physiology, Age, and Chronic Health Evaluation III database and cardiac troponin T levels from patients consecutively admitted to the medical intensive care unit at Mayo Clinic, Rochester, MN, with acute GI bleeding.


METHODS
Between August 2000 and July 2005, 1076 patients with acute GI bleeding consecutively admitted to the medical intensive care units.


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


RESULTS
During hospitalization, 8.0% of deaths occurred in patients with troponin T < 0.01% and 11.9% with troponin T > or = 0.01 (p = 0.083). At 30 days, mortality was 10.1% and 18.8% in patients without and with elevations of troponins, respectively (p < 0.001). The Kaplan-Meier expected probability of survival at 1-, 2-, and 3-yr follow-up was 54.2%, 40.8%, and 30.4% with troponin T > or = 0.01 microg/L and 78.3%, 69.3%, and 61.5% with troponin T < 0.01 microg/L (p < 0.001). After adjustment for severity of disease and baseline characteristics, cardiac troponin levels were associated only with long-term mortality (p < 0.001).


CONCLUSIONS
This is a retrospective, single-center study which included only patients in whom troponin level was determined upon admission.


CONCLUSIONS
In patients with GI bleeding severe enough to require admission to the medical intensive care unit, admission troponin T elevations are associated with long-term but not short-term mortality.
Vasile
Vlad C
VC
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Babuin
Luciano
L
Rio Perez
Jose A
JA
Alegria
Jorge R
JR
Song
Louis M Wong Kee
LM
Chai
High-Seng
HS
Afessa
Bekele
B
Jaffe
Allan S
AS
D018806:APACHE; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
D020107:Troponin T