Does elevated cardiac troponin T predict in-hospital, short-term, and long-term mortality in medical intensive care unit patients independent of disease severity?
Elevated admission cardiac troponin T is an independent predictor of short- and long-term mortality in medical ICU patients, regardless of underlying disease severity.
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. DESIGN: Retrospective study. SETTING: 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. PATIENTS: In all, 1,657 patients consecutively admitted to medical intensive care units between August 2000 and December 2001. MEASUREMENTS: In-hospital, short-term (30-day), and long-term all-cause mortality. RESULTS: During hospitalization, 12.5% of patients with a cardiac troponin T or = 0.01 microg/L (p 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). LIMITATIONS: 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 et al. (Sat,) studied this question.