Cardiac troponin I as a prognostic factor in critically ill pneumonia patients in the absence of acute coronary syndrome

• Published in: Journal of critical care Vol. 30; no. 2; pp. 390 - 394
• Main Authors: Lee, Yeon Joo, MD, Lee, Hongyeul, MD, Park, Ji soo, MD, Kim, Se Joong, MD, Cho, Young-Jae, MD, Yoon, Ho Il, MD, Lee, Jae Ho, MD, Lee, Choon-Taek, MD, Park, Jong Sun, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015; Elsevier Limited
• Subjects: Acute coronary syndromes; Adult; Aged; Aged, 80 and over; Biomarkers - blood; Cardiac troponin; Cardiovascular disease; Cohort Studies; Critical Care; Critical Illness; Female; Heart attacks; Hospitals; Humans; Intensive Care Units; Left ventricular dysfunction; Male; Middle Aged; Mortality; Pneumonia - blood; Pneumonia - mortality; Prognosis; Respiratory failure; Retrospective Studies; Severe pneumonia; Troponin I - blood; Young Adult; Prognosis; Severe pneumonia; Left ventricular dysfunction; HCAP; hospital-acquired pneumonia; Pneumonia Severity Index; pro-BNP; GFR; acute coronary syndrome; Respiratory failure; Acute Physiology and Chronic Health Evaluation II; health care–associated pneumonia; intensive care unit; creatine kinase; Sequential Organ Failure Assessment; ARDS; glomerular filtration rate; cardiac troponin; Mortality; PSI; CK; community-acquired pneumonia; APACHE II; ACS; SOFA; CAP; HAP; acute respiratory distress syndrome; ICU; cTn; pro–brain natriuretic peptide; Cardiac troponin
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.12.001

Abstract Purpose Elevated cardiac troponin (cTn) has been associated with worse outcomes in critically ill patients, but few studies have focused on whether these markers are related to outcomes in patients with severe pneumonia. We investigated the levels of cTnI in critically ill patients hospitalized for severe pneumonia and whether elevated levels of cTnI correlated with the clinical outcome of this patient group. Materials and methods We conducted a retrospective study of patients admitted to the medical intensive care unit (ICU) with severe pneumonia with levels of cTnI obtained within 24 hours of admittance. Patients with evidence of acute coronary syndrome were excluded. A cTnI level greater than 0.034 ng/mL was considered positive. P value < .05 was considered significant. Results A total of 152 patients (community-acquired pneumonia [39.5%], health care–associated pneumonia [40.8%], and hospital-acquired pneumonia [19.7%]) were included in the study. Eighty-eight (58%) patients had detectable cTnI levels (median, 0.049 ng/mL). Patients with increased cTnI levels showed higher in-ICU mortality (38.6% vs 21.9%, P = .028). The association between elevated cTnI levels and mortality remained significant after adjustment using a multivariate model (adjusted hazard ratio = 1.398; 95% confidence interval, 1.005-1.945; P = .047). Conclusions Increased levels of cTnI are an independent predictor of ICU mortality in patients hospitalized with severe pneumonia without evidence of acute coronary syndrome.