Key result
Elevated troponin I is linked to ~102% higher mortality in CAP but adds limited prognostic value.
Why the study?
Cardiac involvement is increasingly recognized in community-acquired pneumonia, prompting investigation into the association between baseline troponin I levels and clinical outcomes, including overall survival.
Does elevated baseline cardiac troponin I predict mortality in hospitalized patients with community-acquired pneumonia?
Cohort (n=491)
Does elevated baseline cardiac troponin I predict mortality in hospitalized patients with community-acquired pneumonia?
Effect estimate: HR 2.016
p-value: p=<.001
While elevated troponin I is independently associated with increased mortality in hospitalized CAP patients, it offers limited incremental prognostic value beyond established clinical risk scores.
Should not yet alter CAP risk stratification; hypothesis-generating for troponin integration into prognostic models.
Cardiac involvement is increasingly recognized in patients with community-acquired pneumonia (CAP). This study aimed to investigate the association between baseline troponin I levels and clinical outcomes, including overall survival, among hospitalized patients with CAP who underwent clinician-directed cardiac evaluation. In this retrospective cohort study, 491 patients were stratified according to baseline cardiac troponin I level (<19.8 ng/L vs ≥19.8 ng/L). Demographic characteristics, comorbidities, laboratory and echocardiographic findings, and clinical outcomes were compared between groups. Survival was analyzed using Kaplan–Meier methods and Cox proportional hazards regression. The median age was 67 years, and 66% were male. Elevated troponin I was detected in 140 patients (28.5%) who were older and had higher rates of coronary artery disease, congestive heart failure, and chronic renal failure, as well as higher Charlson Comorbidity Index (CCI) and Pneumonia Severity Index scores (all P < .05). These patients also had lower left ventricular ejection fraction, higher rates of intensive care unit admission, and in-hospital mortality. During a median follow-up of 439 days, 167 patients (34%) died. Kaplan–Meier analysis showed significantly reduced overall survival in patients with elevated troponin I levels (log-rank P < .001). In multivariate Cox regression analysis, male gender, elevated troponin I (hazard ratio [HR] = 2.016), higher CCI (HR = 1.275), increased blood urea nitrogen to albumin ratio (HR = 2.876), lower hemoglobin levels (HR = 0.841), and reduced ejection fraction (HR = 0.964) were independently associated with mortality. Elevated baseline troponin I was associated with increased mortality and reduced overall survival in this selected high-risk patient population. However, its discriminative performance for mortality was modest (area under the curve [AUC] = 0.64) and lower than that of CCI (AUC = 0.73). The addition of troponin I to a model including age and CCI resulted in only minimal improvement in discrimination (AUC 0.721 vs 0.724), indicating limited incremental prognostic value beyond established risk indices.
No takes yet. Share an insight, caveat, or question.
Gul et al. (2026) conducted a cohort in community-acquired pneumonia (n=491). Elevated baseline cardiac troponin I (≥19.8 ng/L) vs. Normal baseline cardiac troponin I (<19.8 ng/L) was evaluated on mortality (HR 2.016, p=<.001). Elevated baseline troponin I was independently associated with increased mortality (HR 2.016) in hospitalized patients with community-acquired pneumonia, but provided limited incremental prognostic value.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: