Prognostic Value of Initial Elevation in Cardiac Troponin I Level in Critically Ill Patients Without Acute Coronary Syndrome

Abstract

Background Cardiac troponin I levels are often obtained to help rule out acute coronary syndrome. Objective To determine if elevation of troponin level within 24 hours for patients without acute coronary syndrome admitted to the intensive care unit provides important prognostic information. METHODS Patients without acute coronary syndrome admitted to the intensive care unit were prospectively divided into 2 groups according to highest serum level of cardiac troponin I within 24 hours of admission (elevated > 0.049 ng/mL; control ≤ 0.049 ng/mL). Hospital mortality, incidence of intubation, and other parameters were compared between the 2 groups. Results Patients with elevated troponin level (n = 40) had higher mortality than did control patients (n = 50) (35% vs 12%; P = .01). Compared with control patients, patients with elevated levels were more likely to be intubated (41% vs 17%; P = .02). Conclusion Critically ill patients without acute coronary syndrome with elevated levels of cardiac troponin I at admission had higher mortality and more intubations than did control patients.

Clinician Preference for Troponin Monitoring

“…Troponin values, especially the initial troponin, are continuously being reviewed, monitored, and researched (Wu, Bolger, Hollander, 2013). Liu, Shehu, Herrold & Cohen (2015) looked at CTnI levels within a 24-hour period in critically ill patients to determine if the serum level of CTnI in non-ACS patients admitted to the intensive care unit (ICU) or the critical care unit (CCU) have any prognostic value and whether the CTnI results will improve the quality of care and allocation of resources. The study was an observational study conducted on all patients that were admitted to the ICU or CCU at a teaching hospital in the United States.…”

“…Sepsis, heart failure, pulmonary embolism, renal failure, and COPD can all cause an elevation of the CTnI related to cardiac-demand ischemia. An elevated CTnI within 24-hours of admission to ICU or CCU was identified as an increased risk for mortality and higher incidence of intubation in non-ACS critically ill patients (Liu et al, 2015). Lim, Cook, Griffith, Crowther & Deveraux (2006) conducted troponin research to document the elevated levels of the CTnI with 171 patients who were admitted to a ICU for at least a 72-hour stay at a hospital in Ontario.…”

“…Themes found in the literature indicate that a serum troponin level is preferred over the CK-MB because troponin exclusively indicates myocardial damage or ischemia that will decrease the functionality of the myocardium, while the CK-MB is not exclusive to the myocardium (Liu, Shehu, Herrold, Cohen, 2015) identifying cardiac versus non-cardiac causes of a positive troponin, as well as repeated serum draws at specific time intervals, can help identify whether the myocardial damage is of ischemic origin or related to a chronic disease. Further research and evaluation of the hsTrop and CTnI levels need to be conducted to validate which test provide the optimal functioning and best patient outcomes.…”

“…Much of the research focuses on the diagnosis and prompt treatment of ACS because research indicates that a positive troponin increases the morbidity and mortality risk. Further evidence is warranted in the duration and frequency of troponin monitoring following AMI and subsequent cardiac interventions (Liu et al, 2015).…”

“…In the United States, one person will have a myocardial infarction (MI) every 42 seconds (CDC, 2017). With the increasing number of Americans diagnosed with cardiovascular disease, it is important as clinicians, to find ways to accurately diagnose acute coronary syndrome (ACS) and the severity of cardiac damage in a timely fashion (Liu, Shehu, Herrold, & Cohen, 2015). Troponin values can indicate the severity of the injury and research has shown an elevated troponin is highly predictive of increased mortality.…”