Key result
In patients hospitalized with ADHF, detectable or elevated cardiac troponin was associated with increased in-hospital mortality (OR 2.57; 95% CI 2.27-2.91) and long-term mortality.
Why the study?
Does detectable or elevated cardiac troponin predict adverse clinical outcomes in patients hospitalized with acute decompensated heart failure?
Meta-Analysis
Does detectable or elevated cardiac troponin predict adverse clinical outcomes in patients hospitalized with acute decompensated heart failure?
In patients hospitalized with ADHF, elevated or detectable cardiac troponin is a significant prognostic marker for increased length of stay, readmission, and mortality across multiple time horizons.
Supports troponin as prognostic marker in ADHF; hypothesis-generating for troponin-guided interventions in trials.
BACKGROUND: Elevated cardiac troponin (cTn) is often observed in patients with acute decompensated heart failure (ADHF). We assessed the magnitude of association and quality of supporting evidence between cTn and clinically important outcomes in persons hospitalized for ADHF. METHODS: We searched MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through February 28, 2015. The outcomes analyzed included hospital length of stay (LOS), readmissions, and mortality. Random effects meta-analysis was used to combine outcomes across studies. RESULTS: We included 26 clinical studies. A detectable or elevated cTn was associated with increased LOS (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01-1.10), increased in-hospital mortality (OR: 2.57; 95% CI: 2.27-2.91), and a composite of mortality and major adverse events (OR: 1.33; 95% CI: 1.03-1.71) during hospitalization. ADHF patients with a detectable or elevated cTn were at increased risk for mortality and composite of mortality and readmission over the short term (mortality OR: 2.11; 95% CI: 1.43-3.12; composite OR: 2.81; 95% CI: 1.60-4.92), intermediate term (mortality OR: 2.21; 95% CI: 1.46-3.35; composite OR: 2.30; 95% CI: 1.78-2.99), and long term (mortality OR: 3.69; 95% CI: 2.64-5.18; composite OR: 3.49; 95% CI: 2.08-5.84). The overall confidence in estimates was moderate. CONCLUSIONS: Among ADHF patients, a detectable or elevated cTn identifies subjects at increased risk for adverse clinical outcomes during acute hospitalization and those at higher risk for postdischarge mortality and composite of readmission and mortality. Journal of Hospital Medicine 2016;11:446-454. 2016 Society of Hospital Medicine.
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Yousufuddin et al. (2016) conducted a meta-analysis in Acute decompensated heart failure (ADHF). Detectable or elevated cardiac troponin (cTn) vs. Undetectable or non-elevated cTn was evaluated on In-hospital mortality (OR 2.57, 95% CI 2.27-2.91). In patients hospitalized with ADHF, detectable or elevated cardiac troponin was associated with increased in-hospital mortality (OR 2.57; 95% CI 2.27-2.91) and long-term mortality.
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