title: Cardiac Troponin Measurement in the Critically Ill: Potential for Guiding Clinical Management.
abstract: BACKGROUND
  Elevated cardiac troponin (cTn) in the absence of acute coronary syndromes (ACS) is associated with increased mortality in critically ill patients. There are no evidence-based interventions that reduce mortality in this group.
  
  
  OBJECTIVE
  We performed a retrospective investigation of the Veterans Administration Inpatient Evaluation Center database to determine whether drugs used in ACS (β-blockers, aspirin, and statins) are associated with reduced mortality in critically ill patients.
  
  
  METHODS
  Thirty-day mortality was determined for non-ACS patients admitted to any Veterans Administration Intensive Care Unit between October 1, 2007, and September 30, 2008, adjusted for severity of illness. Troponin assay values were normalized across institutions.
  
  
  RESULTS
  Multivariate analyses for 30-day mortality showed an odds ratio (OR) of 1.82 for patients with high cTn (P < 0.0001, cTn > 10% coefficient of variation) and 1.18 for intermediate cTn (P = 0.0021, cTn between lowest limit detectable and 10% coefficient of variation) compared with patients with no elevation, adjusting for severity of illness (n = 19,979). Logistic regression models showed that patients with no or intermediate elevations of cTn taking statins within 24 hours of cTn measurement had a lower mortality than patients not taking statins (OR, 0.66; 95% confidence interval [95% CI], 0.53-0.82; P = 0.0003), whereas patients with high cTn had a lower mortality if they were taking β-blockers or aspirin within 24 hours of cTn measurement compared to patients not taking β-blockers or aspirin (β-blockers: OR, 0.80; 95% CI, 0.68-0.94; P = 0.0077; aspirin: OR, 0.81;95% CI, 0.69-0.96; P = 0.0134).
  
  
  CONCLUSIONS
  This retrospective study confirms an association between elevated troponin and outcomes in critically ill patients without ACS and identifies statins, β-blockers, and aspirin as potential outcome modifiers in a cTn-dependent manner.
authors.affiliation: From the *Department of Veterans Affairs, Office of Informatics and Analytics, Office of Productivity, Efficiency and Staffing; †Cardiology Division, Department of Internal Medicine, Cincinnati Veterans Administration Medical Center; ‡Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati; §Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center; and ∥Department of Environmental Health, University of Cincinnati, Cincinnati, OH.
authors.forename: Stacy
authors.initials: S
authors.lastname: Poe
authors.forename: Robin H
authors.initials: RH
authors.lastname: Vandivier-Pletsch
authors.forename: Michael
authors.initials: M
authors.lastname: Clay
authors.forename: Hector R
authors.initials: HR
authors.lastname: Wong
authors.forename: Erin
authors.initials: E
authors.lastname: Haynes
authors.forename: Florence G
authors.initials: FG
authors.lastname: Rothenberg
mesh_terms: D054058:Acute Coronary Syndrome; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014336:Troponin / Q000097:blood*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014336:Troponin