The prevalence of false-positive cardiac troponin I in ED patients with rhabdomyolysis

Li, Siu Fai; Zapata, Jennifer; Tillem, Elizabeth

doi:10.1016/j.ajem.2005.05.008

Cited by 55 publications

(46 citation statements)

References 18 publications

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“…The study designs included 32 case series , 16 cohort studies (11,(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59), and 4 case control studies (60 -63 ), for a total of 2399 subjects. Of the 52 studies, 16 measured uMb in only a portion of their study group.…”

Section: Study Characteristicsmentioning

confidence: 99%

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Patients with Suspected Rhabdomyolysis: A Systematic Review

et al. 2009

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Background: Urine myoglobin continues to be used as a marker of rhabdomyolysis, particularly to assess risk of developing acute renal failure and evaluate treatment success. We sought to determine the predictive validity of urine myoglobin (uMb) for acute renal failure (ARF) in patients with suspected rhabdomyolysis. Methods: We performed a broad systemic review of the literature from January 1980 to December 2006 using the search terms myoglobin$ AND (renal OR ARF OR kidney). Only primary studies published in English where uMb measurement was related to ARF were included. Results: Of 1602 studies screened, 52 met all selection criteria. The studies covered a wide spectrum of etiologies for rhabdomyolysis, dissimilar diagnostic criteria for ARF and rhabdomyolysis, and various methods of uMb measurement and were mostly case series (n = 32). There was poor reporting on the uMb method, and 17 studies failed to provide any information about the method. The reporting of clinical criteria for ARF with respect to timing, description, performance, and interpretation also lacked adequate detail for replication. Eight studies (total 295 patients) had data for 2-by-2 tables. Sensitivity of the uMb test was 100% in 5 of the 8 studies, specificity varied widely (15% to 88%), and CIs around these measures were high. Pooling of data was not possible because of study heterogeneity. Conclusions: There is inadequate evidence evaluating the use of uMb as a predictor of ARF in patients with suspected rhabdomyolysis.

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Section: Study Characteristicsmentioning

confidence: 99%

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Patients with Suspected Rhabdomyolysis: A Systematic Review

et al. 2009

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“…The present study showed the prevalence of falsely elevated TnI in elderly patients with rhabdomyolysis to be 75.93%, which is relatively higher than previous studies in adults that described its prevalence to be 20.9-50%. [4][5][6] There are many hypotheses supporting falsely elevated TnI in rhabdomyolysis including cardiac stress during rhabdomyolysis, direct injury from skeletal muscle toxic substances to the heart, direct trauma or cardioversion injury, and concomitant infection causing effects to the heart and skeletal muscle. 6 The definite explanation of the higher prevalence of falsely elevated TnI in older adults is yet to be explored; however, there are many concomitant conditions in older adults that lead to elevation of TnI, such as renal insufficiency, falls and fracture, postorthopedic surgery, congestive heart failure, malignancy, and stroke.…”

Section: Prevalence Of False Positive Troponin I In Elderly Patients mentioning

confidence: 99%

Prevalence of false positive troponin I in elderly patients with rhabdomyolysis

Wongrakpanich

Kallis

Prasad

et al. 2017

Geriatrics Gerontology Int

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“…The literature suggests that cTnI can be elevated in patients who also have an elevated total CK in a range consistent with rhabdomyolysis (CK greater than 1,000 IU/L, which (5)is four times the upper limit of normal), as seen in our patient. [16][17][18] However, studies show that the correlation between the severity of rhabdomyolysis and the degree of cTnI elevation is poor, [16][17][18] and the etiology of how rhabdomyolysis causes cTnI elevation remains unknown. One possible mechanism is micro-injury to the myocardium from free radicals, circulating cytokines, cardiotoxicity due to ion fluxes and high acidemia, hypotension and hypoperfusion, and myocardial stretch due to aggressive fluid resuscitation.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with rhabdomyolysis, and thus in whom skeletal forms of troponin I are elevated, the altered background signal-to-noise ratio may result in falsely elevated cTnI. 17 The frequency and degree to which this happens are not known.…”

Section: Discussionmentioning

confidence: 99%

Troponin elevation after black widow spider envenomation

Bush

Davy

2015

CJEM

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Black widow spider envenomation generally results in selflimiting pain that can be treated in the emergency department (ED) with analgesics and benzodiazepines, usually with no further intervention. Occasionally, a patient has to be admitted or treated with antivenom for refractory pain or a venom-induced complication. We present the case of an 84-year-old man who presented to our ED with chest pain and dyspnea after being bitten on the foot by a western black widow spider (Lactrodectus hesperus). His initial cardiac troponin I (cTnI) was elevated at 0.07 ng/ml and continued to rise to a peak of 0.17 ng/ml. He also had rhabdomyolysis, another uncommon complication of black widow envenomation. An elevated cTnI generally signifies myocardial injury and is rarely seen after black widow envenomation. We discuss the possible etiologies for an elevated cardiac biomarker, in this context, and review potentially serious complications of widow spider envenomation presenting with chest symptoms and an elevated cardiac biomarker. RÉSUMÉL'envenimement par piqûre de veuve noire entraîne généralement une douleur qui tend à disparaître spontané-ment et qui peut se traiter au service des urgences (SU) par des analgésiques et des benzodiazépines, habituellement sans autre intervention. Il arrive toutefois que des patients soient hospitalisés ou soient traités par des antivenins pour des douleurs rebelles ou pour des complications causées par le venin. Sera exposé ici le cas d'un homme de 84 ans qui a consulté au SU pour des douleurs thoraciques et de la dyspnée après une piqûre de veuve noire (Lactrodectus hesperus) au pied. Le taux de troponine I cardiaque (t. Ic) à l'arrivée s'élevait à 0,07 ng/ml et a continué d'augmenter pour atteindre un pic de 0,17 ng/ml. Le patient a également souffert de rhabdomyolyse, une autre complication peu fréquente de l'envenimement par piqûre de veuve noire. Une élévation du taux de t. Ic signe généralement une lésion myocardique, et le phénomène s'observe rarement à la suite d'un envenimement par piqûre de veuve noire. Il sera question ici des causes possibles de l'élévation du taux de biomarqueur cardiaque dans le contexte, ainsi que des complications potentiellement graves de l'envenimement par piqûre de veuve noire, qui produit des symptômes de type thoracique et une élévation du taux de biomarqueur cardiaque.

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The prevalence of false-positive cardiac troponin I in ED patients with rhabdomyolysis

Cited by 55 publications

References 18 publications

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Patients with Suspected Rhabdomyolysis: A Systematic Review

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Patients with Suspected Rhabdomyolysis: A Systematic Review

Prevalence of false positive troponin I in elderly patients with rhabdomyolysis

Troponin elevation after black widow spider envenomation

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