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Ostermann, Marlies; Lo, Jessica; Toolan, Michael; Tuddenham, Emma; Sanderson, Barnaby; Lei, Katie; Smith, John; Griffiths, Anna; Webb, Ian; Coutts, James; Chambers, John; Collinson, Paul; Peacock, Janet; Bennett, David; Treacher, David (2014)
Publisher: BioMed Central
Journal: Critical Care
Languages: English
Types: Article
Subjects: Critical Care and Intensive Care Medicine, Research
Introduction Troponin T (cTnT) elevation is common in patients in the Intensive Care Unit (ICU) and associated with morbidity and mortality. Our aim was to determine the epidemiology of raised cTnT levels and contemporaneous electrocardiogram (ECG) changes suggesting myocardial infarction (MI) in ICU patients admitted for non-cardiac reasons. Methods cTnT and ECGs were recorded daily during week 1 and on alternate days during week 2 until discharge from ICU or death. ECGs were interpreted independently for the presence of ischaemic changes. Patients were classified into four groups: (i) definite MI (cTnT ≥15 ng/L and contemporaneous changes of MI on ECG), (ii) possible MI (cTnT ≥15 ng/L and contemporaneous ischaemic changes on ECG), (iii) troponin rise alone (cTnT ≥15 ng/L), or (iv) normal. Medical notes were screened independently by two ICU clinicians for evidence that the clinical teams had considered a cardiac event. Results Data from 144 patients were analysed (42% female; mean age 61.9 (SD 16.9)). A total of 121 patients (84%) had at least one cTnT level ≥15 ng/L. A total of 20 patients (14%) had a definite MI, 27% had a possible MI, 43% had a cTNT rise without contemporaneous ECG changes, and 16% had no cTNT rise. ICU, hospital and 180-day mortality was significantly higher in patients with a definite or possible MI. Only 20% of definite MIs were recognised by the clinical team. There was no significant difference in mortality between recognised and non-recognised events. At the time of cTNT rise, 100 patients (70%) were septic and 58% were on vasopressors. Patients who were septic when cTNT was elevated had an ICU mortality of 28% compared to 9% in patients without sepsis. ICU mortality of patients who were on vasopressors at the time of cTnT elevation was 37% compared to 1.7% in patients not on vasopressors. Conclusions The majority of critically ill patients (84%) had a cTnT rise and 41% met criteria for a possible or definite MI of whom only 20% were recognised clinically. Mortality up to 180 days was higher in patients with a cTnT rise.
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    • 1. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, Katus HA, Lindahl B, Morrow DA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasché P, Ravkilde J, Ohman EM, Antman EM, et al: Third universal definition of myocardial infarction. Circulation 2012, 126:2020-2035.
    • 2. Lim W, Holinski P, Devereaux PJ, Tkaczyk A, McDonald E, Clarke F, Qushmaq I, Terrenato I, Schunemann H, Crowther M, Cook D: Detecting myocardial infarction in critical illness using screening troponin measurements and ECG recordings. Crit Care 2008, 12:R36.
    • 3. 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, 15:280-288.
    • 4. Bessiere F, Khenifer S, Dubourg J, Durieu I, Lega JC: Prognostic value of troponin in sepsis: a meta-analysis. Intensive Care Med 2013, 39:1181-1189.
    • 5. Hamilton MA, Toner A, Cecconi M: Troponin in critically ill patients. Minerva Anestesiol 2012, 78:1039-1045.
    • 6. Landesberg G, Vesselov Y, Einav S, Goodman S, Sprung CL, Weissman C: Myocardial ischemia, cardiac troponin, and long-term survival of high-cardiac risk critically ill intensive care unit patients. Crit Care Med 2005, 33:1281-1287.
    • 7. Audimooolam VK, McPhail MJ, Sherwood R, Willars C, Bernal W, Wendon JA, Auzinger G: Elevated troponin I and its prognostic significance in acute liver failure. Crit Care 2012, 16:R228.
    • 8. Lim W, Whitlock R, Khera V, Devereaux PJ, Tkaczyk A, Heels-Ansdell D, Jacka M, Cook D: Etiology of troponin elevation in critically ill patients. J Crit Care 2010, 25:322-328.
    • 9. Agewall S, Giannitsis E, Jernberg T, Katus H: Troponin elevation in coronary vs. non-coronary disease. Eur Heart J 2011, 32:404-411.
    • 10. Wu AH: Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression? Intensive Care Med 2001, 27:959-961.
    • 11. Maeder M, Fehr T, Rickli H, Amman P: Sepsis-associated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides. Chest 2006, 129:1349-1366.
    • 12. Ver Elst KM, Spapen HD, Nguyen DN, Garbar C, Huyghens LP, Gorus FK: Cardiac troponins I and T are biological markers of left ventricular dysfunction in septic shock. Clin Chem 2000, 46:650-657.
    • 13. Klein Gunnewiek JM, van de Leur JJ: Elevated troponin T concentrations in critically ill patients. Intensive Care Med 2003, 29:2317-2322.
    • 14. Lim W, Qushmaq I, Cook DJ, Crowther MA, Heels-Ansdell D, Devereaux PJ, Troponin T Trials Group: Elevated Troponin and myocardial infarction in the intensive care unit: a prospective study. Crit Care 2005, 9(6):R636-644.
    • 15. Collinson PO, Heung YM, Gaze D, Boa F, Senior R, Christenson R, Apple FS: Influence of population selection on the 99th percentile reference value for cardiac troponin assays. Clin Chem 2012, 58:219-225.
    • 16. Reynolds T, Cecconi M, Collinson P, Rhodes A, Grounds RM, Hamilton MA: Raised serum cardiac troponin I concentrations predict hospital mortality in intensive care unit patients. Br J Anaesth 2012, 109:219-224.
    • 17. Aviles RJ, Askari AT, Lindahl B, Wallentin L, Jia G, Ohman EM, Mahaffey KW, Newby LK, Califf RM, Simoons ML, Topol EJ, Berger P, Lauer MS: Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. N Engl J Med 2002, 346:2047-2052.
    • 18. Spies C, Haude V, Fitzner R, Schröder K, Overbeck M, Runkel N, Schaffartzik W: Serum cardiac troponin T as a prognostic marker in early sepsis. Chest 1998, 113:1055-1063.
    • 19. Guest TM, Ramanathan AV, Tuteur PG, Schechtman KB, Ladenson JH, Jaffe AS: Myocardial injury in critically ill patients. A frequently unrecognized complication. JAMA 1995, 273:1945-1949.
    • 20. Lim W, Qushmaq I, Cook DJ, Devereaux PJ, Heels-Ansdell D, Crowther MA, Tkaczyk A, Meade MO, Cook DJ: Reliability of electrocardiogram interpretation in critically ill patients. Crit Care Med 2006, 34:1338-1343.
    • 21. Mehta S, Granton J, Lapinsky SE, Newton G, Bandayrel K, Little A, Siau C, Cook DJ, Ayers D, Singer J, Lee TC, Walley KR, Storms M, Cooper J, Holmes CL, Hebert P, Gordon AC, Presneill J, Russell JA, Vasopressin and Septic Shock Trial (VASST) Investigators: Agreement in electrocardiogram interpretation in patients with septic shock. Crit Care Med 2011, 39:2080-2086.
    • 22. Rennyson SL, Hunt J, Haley MW, Norton HJ, Littmann L: Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: an observational cohort analysis. Crit Care Med 2010, 38:2304-2309.
    • 23. Ammann P, Maggiorini M, Bertel O, Haenseler E, Joller-Jemelka HI, Oechslin E, Minder EI, Rickli H, Fehr T: Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes. J Am Coll Cardiol 2003, 41:2004-2009.
    • 24. Walsh TS, McClelland DB, Lee RJ, Garrioch M, Maciver CR, McArdle F, Crofts SL, Mellor I, ATICS Study Group: Prevalence of ischaemic heart disease at admission to intensive care and its influence on red cell transfusion thresholds: multicentre Scottish Study. Br J Anaesth 2005, 94:445-452.
    • 25. Stein R, Gupta B, Agarwal S, Golub J, Bhutani D, Rosman A, Eng C: Prognostic implications of normal (<0.10 ng/ml) and borderline (0.10 to 1.49 ng/ml) troponin elevation levels in critically ill patients without acute coronary syndrome. Am J Cardiol 2008, 102:509-512.
    • 26. Babuin L, Vasile VC, Rio Perez JA, Alegria JR, Chai HS, Afessa B, Jaffe AS: Elevated cardiac troponin is an independent risk factor for short- and long-term mortality in medical intensive care unit patients. Crit Care Med 2008, 36:759-765.
    • 27. Vasile VC, Babuin L, Rio Perez JA, Alegria JR, Song LM, Chai HS, Afessa B, Jaffe AS: Long-term prognostic significance of elevated cardiac troponin levels in critically ill patients with acute gastrointestinal bleeding. Crit Care Med 2009, 37:140-147.
    • 28. Wu TT, Yuan A, Chen CY, Chen WJ, Luh KT, Kuo SH, Lin FY, Yang PC: Cardiac troponin I levels are a risk factor for mortality and multiple organ failure in noncardiac critically ill patients and have an additive effect to the APACHE II score in outcome prediction. Shock 2004, 22:95-101.
    • 29. 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, 31:2598-2603.
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