DOI: http://dx.doi.org/10.18203/2349-3933.ijam20172547

Study of troponin-t elevation in critically ill patients-incidence and outcome

Augustine Sabu, S. Madhu, Shilpa Avarebeel, Sruthy Velangupara, Mohan Goudar

Abstract


Background: Besides cardiac disease, critical illness patients are often subjected to myocardial injury. Hence, the goal of present study was to analyze the incidence of elevated cardiac troponin levels in critically ill patients and its outcome which in turn can act as a prognostic marker.

Methods: The settings were the ICU’s of a tertiary care hospital in south India. A sample of 54 was identified using purposive sampling technique. Serial monitoring of troponin T was done on day 1, 3 and 5. A performa was used to collect the baseline data of who met the inclusion and exclusion criteria. The collected data was analyzed by using descriptive and inferential statistics.

Results: Among 54 patients 17 (31.5%) of them expired. It was found that patients with mean APACHE score were significantly greater among mortality group (P<0.001). When analyzing the outcome in relation to the troponin T levels, it can be concluded that troponin levels were higher among patients who died but it was not statistically significant. (p=0.56, 0.84 and 0.67 on day 1, 3 and 5 respectively). Among the 54 patients it is inferred from the findings that most of the critically ill patients do have high troponin T levels.

Conclusions: The study illustrated the incidence of high troponin T levels in critically ill patients which is an informative prognostic indicator. The relation couldn’t be proved due to less sample size and other imposing factors in critically ill such as broad diagnostic categories.

 


Keywords


Cardiac troponin, Outcome, Diagnostic utility, Prognosis

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References


Hamm CW, Ravkilde J, Gerhardt W, Jorgensen P, Peheim E, Ljungdahl L, et al. The prognostic value of serum troponin T in unstable angina. N Engl J Med. 1992;327:146-50.

Wu AH. Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression? Intensive Care Med. 2001;27:959-61.

Parrillo JE. Pathogenetic mechanisms of septic shock. N Engl J Med. 1993;328:1471-7.

Guest TM, Ramanathan AV, Tuteur PG, Schechtman KB, Ladenson JH, Jaffe AS. Myocardial injury in critically ill patients. A frequently unrecognized complication. JAMA. 1995;273:1945-9.

Ammann P, Fehr T, Minder EI, Gunter C, Bertel O. Elevation of troponin I in sepsis and septic shock. Intensive Care Med. 2001;27:965-9.

Ammann P, Maggiorini M, Bertel O, Haenseler E, Joller-Jemelka HI, Oechslin E, et al. Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes. J Am Coll Cardiol. 2003;41:2004-9.

Arlati S, Brenna S, Prencipe L, Marocchi A, Casella GP, Lanzani M, et al. Myocardial necrosis in ICU patients with acute non-cardiac disease: a prospective study. Intensive Care Med. 2000;26:31-7.

Bakshi TK, Choo MK, Edwards CC, Scott AG, Hart HH, Armstrong GP. Causes of elevated troponin I with a normal coronary angiogram. Intern Med J. 2002;32:520-5.

Homma S, Grahame-Clarke C. myocardial damage in patients with subarachnoid hemorrhage. Stroke. 2004;35:552-3.

Relos RP, Hasinoff IK, Beilman GJ. Moderately elevated serum troponin concentrations are associated with increased morbidity and mortality rates in surgical intensive care unit patients. Crit Care Med. 2003;31:2598-603.

Lim W, Cook DJ, Griffith LE, Crowther MA, Devereaux PJ. Elevated cardiac troponin levels in critically ill patients: prevalence, incidence, and outcomes. Am J Crit Care. 2006;15:3-281.

Turner A, Tsamitros M, Bellomo R. Myocardial cell injury in septic shock. Crit Care Med. 1999;27:1775-80.

Fernandes CJ, Akamine N, Knobel E. Cardiac troponin: a new serum marker of myocardial injury in sepsis. Intensive Care Med. 1999;25:1165-8.

Setsuta K, Seino Y, Takahashi N. Clinical significance of elevated levels of cardiac troponin T in patients with chronic heart failure. Am J Cardiol. 1999;84(5):608-611A609.

Perna ER, Macin SM, Parras JI. Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema. Am Heart J. 2002;143(5):814-20.

Guest TM, Ramanathan AV, Tuteur PG, Schechtman KB, Ladenson JH, Jaffe AS. Myocardial injury in critically ill patients. A frequently unrecognized complication. JAMA. 1995;273(24):1945-9.

Ostermann M, Lo J, Toolan M, Tuddenham E, Sanderson B, Lei K, Smith J, Griffiths A, Webb I, Coutts J, Chambers J. A prospective study of the impact of serial troponin measurements on the diagnosis of myocardial infarction and hospital and six-month mortality in patients admitted to ICU with non-cardiac diagnoses. Critical Care. 2014 Apr 4;18(2):R62.

Kollef MH, Ladenson JH, Eisenberg PR. Clinically recognized cardiac dysfunction: an independent determinant of mortality among critically ill patients. Is there a role for serial measurement of cardiac troponin I? Chest. 1997;111(5):1340-7.

Chen F, Lu G, Fan B, Xu P, Chen Z. High level of troponin I decreases the one-year survival rate of non-cardiac critically ill patients. J Exp Clin Cardiol. 2014;20(1):1-14.