Etiology of troponin elevation in critically ill patients.
OBJECTIVE
The aim of this study was to assess the etiology of cardiac troponin elevation among patients admitted to the intensive care unit (ICU) and to examine whether etiology affects mortality and length of stay.


METHODS
All patients admitted over 2 months underwent screening with troponin measurements and were included if 1 or more measurements were elevated. Two adjudicators retrospectively reviewed patient charts to determine the likely cause of troponin elevation.


RESULTS
Of 103 patient admissions, 52 (50.5%) had 1 or more elevated troponin measurements, and 49 (94.2%) had medical charts available for review. Troponin elevation was adjudicated as myocardial infarction (MI) in 53.1% of patients, sepsis in 18.4%, renal failure in 12.2%, and other causes in 16.3%. Overall ICU mortality was 16.0%; 2.0% for patients with no troponin elevation, 23.1% in patients with MI, and 39.1% in patients with troponin elevation not due to MI. Having an elevated troponin level not due to MI was significantly associated with increased hospital mortality compared with having no troponin elevation.


CONCLUSIONS
The most common cause of troponin elevation among critically ill patients was MI. Patients with elevated troponin had worse outcomes compared with patients without troponin elevation, and troponin elevation not due to MI was predictive of increased hospital mortality.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada L8N 3Z5. limwp@mcmaster.ca
Wendy
W
Lim
Richard
R
Whitlock
Vikas
V
Khera
Philip J
PJ
Devereaux
Andrea
A
Tkaczyk
Diane
D
Heels-Ansdell
Michael
M
Jacka
Deborah
D
Cook
D000368:Aged; D016638:Critical Illness; D005260:Female; D006333:Heart Failure / Q000097:blood; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D010043:Outcome and Process Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood; D051437:Renal Insufficiency / Q000097:blood; D012189:Retrospective Studies; D014336:Troponin / Q000097:blood*
D014336:Troponin