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Distribution of high-sensitivity troponin taken without conventional clinical indications in critical care patients and its association with mortality

Distribution of high-sensitivity troponin taken without conventional clinical indications in critical care patients and its association with mortality
Distribution of high-sensitivity troponin taken without conventional clinical indications in critical care patients and its association with mortality
Objectives:
To describe the distribution of high-sensitivity troponin in a consecutive cohort of patients in critical care units, regardless of clinical indication, and its association with clinical outcomes.

Design:
Prospective observational study.

Setting:
Single-center teaching hospital.

Patients:
Consecutive patients admitted to two adult critical care units (general critical care unit and neuroscience critical care unit) over a 6-month period.

Interventions:
All patients had high-sensitivity troponin tests performed at admission and tracked throughout their critical care stay, regardless of whether the supervising team felt there was a clinical indication. The results were not revealed to patients or clinicians unless clinically requested.

Measurements and Main Results:
There were 1,033 patients in the study cohort (general critical care unit 750 and neuroscience critical care unit 283). The median high-sensitivity troponin was 21 ng/L (interquartile range, 7–86 ng/L), with 560 patients (54.2%) above the upper limit of normal as defined by the manufacturer. Admission high-sensitivity troponin concentrations above the upper limit of normal in general critical care unit and neuroscience critical care unit were associated with increasing age, comorbidity, markers of illness severity, and the need for organ support. On adjusted analysis, the high-sensitivity troponin concentration remained an independent predictor of critical care mortality in general critical care unit and neuroscience critical care unit.

Conclusions:
High-sensitivity troponin elevation, taken outside the context of conventional clinical indications, was common in the critically ill. Such elevations were associated with increasing age, comorbidity, illness severity, and the need for organ support. Admission high-sensitivity troponin concentration is an independent predictor of critical care mortality and as such may represent a novel prognostic biomarker at admission.
high-sensitivity troponin, intensive care
0090-3493
1451-1459
Hinton, Jonathan
3d2fa767-e092-41d8-a4e4-2858c84192c1
Maclyn, Augustine
fd59fa0c-2339-4e4d-b4b9-65f6d54299ff
Gabara, Lavinia
dce5d515-e383-4d27-b441-e3ce8542d090
Mariathas, Mark
e8dbbe0d-d303-41a4-a5a2-fa8900accfe6
Allan, Rick
2726ab31-1430-4275-becc-461fb4023442
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Nicholas, Zoe
98403583-c418-45ad-836b-1831517dcc5f
Beecham, Ryan
f930648f-5bcb-4c56-ae34-61db6d54b251
Gillett, Neil
3d65706b-b3d5-480e-8480-9af3ed98f11b
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Cook, Paul
cd9623d3-5c1b-4ced-ab67-4cf9b621a1a3
Grocott, Michael P. W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Hinton, Jonathan
3d2fa767-e092-41d8-a4e4-2858c84192c1
Maclyn, Augustine
fd59fa0c-2339-4e4d-b4b9-65f6d54299ff
Gabara, Lavinia
dce5d515-e383-4d27-b441-e3ce8542d090
Mariathas, Mark
e8dbbe0d-d303-41a4-a5a2-fa8900accfe6
Allan, Rick
2726ab31-1430-4275-becc-461fb4023442
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Nicholas, Zoe
98403583-c418-45ad-836b-1831517dcc5f
Beecham, Ryan
f930648f-5bcb-4c56-ae34-61db6d54b251
Gillett, Neil
3d65706b-b3d5-480e-8480-9af3ed98f11b
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Cook, Paul
cd9623d3-5c1b-4ced-ab67-4cf9b621a1a3
Grocott, Michael P. W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4

Hinton, Jonathan, Maclyn, Augustine, Gabara, Lavinia, Mariathas, Mark, Allan, Rick, Borca, Florina, Nicholas, Zoe, Beecham, Ryan, Gillett, Neil, Kwok, Chun Shing, Cook, Paul, Grocott, Michael P. W., Mamas, Mamas and Curzen, Nick (2021) Distribution of high-sensitivity troponin taken without conventional clinical indications in critical care patients and its association with mortality. Critical Care Medicine, Publish ahead o, 1451-1459. (doi:10.1097/CCM.0000000000005024).

Record type: Article

Abstract

Objectives:
To describe the distribution of high-sensitivity troponin in a consecutive cohort of patients in critical care units, regardless of clinical indication, and its association with clinical outcomes.

Design:
Prospective observational study.

Setting:
Single-center teaching hospital.

Patients:
Consecutive patients admitted to two adult critical care units (general critical care unit and neuroscience critical care unit) over a 6-month period.

Interventions:
All patients had high-sensitivity troponin tests performed at admission and tracked throughout their critical care stay, regardless of whether the supervising team felt there was a clinical indication. The results were not revealed to patients or clinicians unless clinically requested.

Measurements and Main Results:
There were 1,033 patients in the study cohort (general critical care unit 750 and neuroscience critical care unit 283). The median high-sensitivity troponin was 21 ng/L (interquartile range, 7–86 ng/L), with 560 patients (54.2%) above the upper limit of normal as defined by the manufacturer. Admission high-sensitivity troponin concentrations above the upper limit of normal in general critical care unit and neuroscience critical care unit were associated with increasing age, comorbidity, markers of illness severity, and the need for organ support. On adjusted analysis, the high-sensitivity troponin concentration remained an independent predictor of critical care mortality in general critical care unit and neuroscience critical care unit.

Conclusions:
High-sensitivity troponin elevation, taken outside the context of conventional clinical indications, was common in the critically ill. Such elevations were associated with increasing age, comorbidity, illness severity, and the need for organ support. Admission high-sensitivity troponin concentration is an independent predictor of critical care mortality and as such may represent a novel prognostic biomarker at admission.

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More information

Published date: September 2021
Additional Information: Publisher Copyright: © 2021 Lippincott Williams and Wilkins. All rights reserved.
Keywords: high-sensitivity troponin, intensive care

Identifiers

Local EPrints ID: 450368
URI: http://eprints.soton.ac.uk/id/eprint/450368
ISSN: 0090-3493
PURE UUID: 7fc85b69-93e5-4a58-839d-fae8fd3c31c5
ORCID for Michael P. W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 26 Jul 2021 16:31
Last modified: 17 Mar 2024 03:17

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Contributors

Author: Jonathan Hinton
Author: Augustine Maclyn
Author: Lavinia Gabara
Author: Mark Mariathas
Author: Rick Allan
Author: Florina Borca
Author: Zoe Nicholas
Author: Ryan Beecham
Author: Neil Gillett
Author: Chun Shing Kwok
Author: Paul Cook
Author: Mamas Mamas
Author: Nick Curzen ORCID iD

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