Prevalence and Significance of Elevated Troponin I and Statin use mong Unselected Critically Ill Patients

Objectives: to determine the prevalence and significance of elevated troponin, myocardial infarction (MI), and statin use on mortality among unselected critically ill patients Design: non-blinded prospective observational cohort study Disclosures: None Setting: mixed medical-surgical university tertiary critical care unit Patients: all consecutive unselected patients admitted to the intensive care unit during a representative four month period Interventions: none Measurements and main results: among 335 consecutive patients with an average age of 54.3 years and APACHE II score of 21.2, troponin I was elevated (> 0.15 mcg/L) in 94 patients (28%). EKG changes were present in 119 (35%). MI occurred after admission in 39 patients (12%), of whom 15 died (38%). Overall mortality was 94 (28%). In the multivariable analysis of mortality, the following were significant (Odds Ratio, p value): age (1.03, 0.01), APACHE II score (1.10, 0.0001), troponin elevation > 0.15 mcg/L (3.21, 0.003), MI (2.75, 0.04), and statin use (0.35, 0.02). Nonsignificant factors included body-mass index, diagnostic group, preexisting heart disease or diabetes, and use of beta blockers, angiotensin-converting enzyme inhibitors (ACEI), or aspirin. ACEI was associated with increased mortality in the univariable analysis. Conclusions: Isolated elevated troponin I is closely associated with mortality among unselected critically ill patients. Statin use was associated with reduced mortality in the same patients. Further examination of this association, to determine mechanism, and to evaluate prevention, is appropriate.