Key result
Inpatient troponin I testing was associated with increased odds of 30-day hospital readmission (OR 2.24; 95% CI 2.08-2.41; p<0.0001), whereas a positive result did not predict readmission.
Why the study?
While troponin I elevation correlates with increased mortality, it remains unclear whether troponin I testing or elevation has value for predicting hospital readmissions.
Does inpatient Troponin I testing or a positive Troponin I result predict 30-day hospital readmission in hospitalized patients?
Cohort (n=54,039)
Does inpatient Troponin I testing or a positive Troponin I result predict 30-day hospital readmission in hospitalized patients?
While the act of ordering a Troponin I test is associated with higher 30-day readmission rates, a positive troponin result itself does not independently predict 30-day hospital readmission.
Troponin I testing may flag inpatients for targeted readmission prevention; leaves open whether ordering reflects severity or influences outcomes.
Introduction: Troponin I (TnI) elevation is an important tool for detecting cardiac injury, though it is not disease specific and can be elevated in other conditions such as sepsis or heart failure. Predictive models suggest that TnI elevation correlates with increased mortality, however, it is unclear if TnI testing or elevation has value for predicting readmissions. Hypothesis: We hypothesized inpatient TnI testing would correlate with 30-day hospital readmissions. Methods: Patient data was collected from January 1st , 2016 through December 31st , 2016 and was comprised of 54,039 patients. Analysis was performed on TnI positive patients and correlated with 30-day hospital readmission rates among the entire cohort as well as those subdivided by ICD-10 codes into acute myocardial infarction (AMI), sepsis, pulmonary disease, and cardiac non-AMI. A subsequent propensity-matched logistic regression was performed among the entire cohort with TnI testing as well as resultant positive TnI to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: Among the entire cohort, 4,572 patients (8.5%) were readmitted within 30 days. TnI testing was associated with increased readmission within 30 days (3,428/30,173; 11.4%; p<0.0001). Logistic regression analysis revealed an increased odds ratio for 30-day readmission of 2.24 (95% CI [2.08-2.41]; p<0.0001) among those with TnI draw. In those with a resultant positive troponin, however, the odds of 30-day readmission were 1.04 (95% CI [0.95-1.14]; p=0.4006). Although there was no significant increase in 30-day readmission among the AMI cohort who had troponin draw (n=1,722; OR 3.66, 95% CI [0.97-32.53], p=0.12), there were significant increases among those admitted for sepsis (n=4,834; OR 2.41, 95% CI [1.84-3.22], p<0.0001), pulmonary disease (n=2,120; OR 3.92, 95% CI [2.07-8.55], p<0.0001), and cardiac non-AMI (n=9,808; OR 2.34, 95% CI [2.15-2.56], p<0.0001). Conclusions: Hospital readmission within 30 days is associated with TnI testing and may be further predictive in non-AMI ICD-10 diagnoses such as sepsis, pulmonary disease, and non-AMI cardiac disease. However, a positive TnI may not be a useful objective data point for prediction of hospital readmission within 30 days.
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Payne et al. (2020) conducted a cohort in Hospitalized patients (n=54,039). Troponin I testing vs. No Troponin I testing was evaluated on 30-day hospital readmission (OR 2.24, 95% CI 2.08-2.41, p=<0.0001). Inpatient troponin I testing was associated with increased odds of 30-day hospital readmission (OR 2.24; 95% CI 2.08-2.41; p<0.0001), whereas a positive result did not predict readmission.
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