Raised troponin I in Chinese patients with acute pulmonary embolism suggests complicated clinical course and may predict intensive care unit admission

Background and Aims: Emergency Response Teams have been employed by hospitals to evaluate and manage patients whose condition is rapidly deteriorating. In this study, we aimed to assess the outcomes of triggering the Emergency Response Teams at a high-volume arthroplasty center, determine which factors trigger the Emergency Response Teams, and investigate the main reasons for an unplanned intensive care unit admission following Emergency Response Team intervention. Material and Methods: We gathered data by evaluating all Emergency Response Team forms filled out during a 4-year period (2014–2017), and by assessing the medical records. The collected data included age, gender, time of and reason for the Emergency Response Teams call, and interventions performed during the Emergency Response Teams intervention. The results are reported as percentages, mean ± standard deviation, or median (interquartile range), where appropriate. All patients were monitored for 30 days to identify possible intensive care unit admissions, surgeries, and death. Results: The mean patient age was 72 (46–92) years and 40 patients (62%) were female. The Emergency Response Teams was triggered a total of 65 times (61 patients). The most common Emergency Response Team call criteria were low oxygen saturation, loss or reduction of consciousness, and hypotension. Following the Emergency Response Team call, 36 patients (55%) could be treated in the ward, and 29 patients (45%) were transferred to the intensive care unit. The emergency that triggered the Emergency Response Teams was most commonly caused by drug-related side effects (12%), pneumonia (8%), pulmonary embolism (8%), and sepsis (6%). Seven patients (11%) died during the first 30 days after the Emergency Response Teams call. Conclusion: Although all 65 patients met the Emergency Response Teams call criteria, potentially having severe emergencies, half of the patients could be treated in the arthroplasty ward. Emergency Response Team intervention appears useful in addressing concerns that can potentially lead to unplanned intensive care unit admission, and the Emergency Response Teams trigger threshold seems appropriate as only 3% of the Emergency Response Teams calls required no intervention.

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Use of hospital resources in the care of patients with intermediate risk pulmonary embolism

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620921601 ◽

2020 ◽

pp. 204887262092160

Author(s):

Alexander E Sullivan ◽

Tara Holder ◽

Tracy Truong ◽

Cynthia L Green ◽

Olamiji Sofela ◽

...

Keyword(s):

Intensive Care Unit ◽

Pulmonary Embolism ◽

Intensive Care ◽

High Risk ◽

Length Of Stay ◽

Intensive Care Unit Admission ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Intermediate Risk ◽

Risk Patients

Background Risk stratification and management of hemodynamically stable pulmonary embolism remains challenging. Professional societies have published stratification schemes, but little is known about the management of patients with intermediate risk pulmonary embolism. We describe the care of these patients at an academic health system. Methods Patient encounters from 1 January 2016 to 30 June 2017 were retrospectively identified utilizing a multihospital, electronic health record-based data warehouse. Using the 2019 European Society of Cardiology criteria, differences in hospital resource utilization, defined as intensive care unit admission, use of invasive therapies, and length of stay, were examined in patients with intermediate risk characteristics. Results A cohort of 322 intermediate risk patients, including 165 intermediate–low and 157 intermediate–high risk patients, was identified. Intermediate–high risk patients more often underwent catheter-directed therapy (14.0% vs. 1.8%; P<0.001) compared to intermediate–low risk patients and had a 50% higher rate of intensive care unit admission (relative risk 1.50; 95% confidence interval 1.06, 2.12; P=0.023). There was no difference in median intensive care unit length of stay (2.7 vs. 2.0 days; P=0.761) or hospital length of stay (5.0 vs. 5.0 days; P=0.775) between intermediate–high risk and intermediate–low risk patients. Patients that underwent invasive therapies had a 3.8-day shorter hospital length of stay (beta –3.75; 95% confidence interval –6.17, –1.32; P=0.002). Conclusion This study presents insights into the hospital resource utilization of patients with intermediate risk pulmonary embolism. The 2019 European Society of Cardiology risk stratification criteria are a clinically relevant scheme that identifies patients more often treated with intensive care unit admission and advanced therapies.

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Abstract 335 Can elevated troponin I levels predict complicated clinical course and in-hospital mortality in patients with acute pulmonary embolism?

European Journal of Emergency Medicine ◽

10.1097/00063110-200602000-00032 ◽

2006 ◽

Vol 13 (1) ◽

pp. 53

Author(s):

Ersin Aksay ◽

Sedat Yanturali ◽

Selahattin Kiyan

Keyword(s):

Pulmonary Embolism ◽

Hospital Mortality ◽

Acute Pulmonary Embolism ◽

Troponin I ◽

Clinical Course ◽

Elevated Troponin

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Epidemiologic features and clinical course of COVID-19: a retrospective analysis of 19 patients in Germany

Future Virology ◽

10.2217/fvl-2020-0256 ◽

2021 ◽

Author(s):

Sara Elgamasy ◽

Eman Elsayed Sakr ◽

Mohamed Gomaa Kamel ◽

Sherief Ghozy ◽

Ghadeer Gamal Elsayed ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Infection Control ◽

Intensive Care Unit Admission ◽

Retrospective Analysis ◽

Clinical Course ◽

Symptomatic Treatment ◽

Cardiac Diseases ◽

Effective Strategies ◽

Epidemiologic Features

Background: SARS-coronavirus-2 causes coronavirus disease-19 (COVID-19). Materials & methods: We here report epidemiology; clinical, radiological and laboratory characteristics; and outcomes of COVID-19 in 19 patients confirmed by reverse-transcriptase–PCR. Results: In 19 PCR-confirmed cases (median age 69 years; 63% males), the most common presentations were fever (79%), cough (79%) and fatigue (79%). The most common comorbidities were hypertension (47%), hypothyroidism (32%) and cardiac diseases (32%). All patients received symptomatic treatment. Ampicillin/sulbactam was prescribed for 50% of cases. Also, 13 (68.4%) recovered and discharged, 9 (47.3%) needed intensive care unit admission and 4 (21.1%) cases died Conclusion: The included cases had variable clinical outcomes following supportive and antibiotic treatments. These findings may contribute to development of more effective strategies for infection control.

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Tissue perfusion alterations correlate with mortality in patients admitted to the intensive care unit for acute pulmonary embolism

Medicine ◽

10.1097/md.0000000000011993 ◽

2018 ◽

Vol 97 (42) ◽

pp. e11993 ◽

Cited By ~ 2

Author(s):

Tomas Urbina ◽

Naïke Bigé ◽

Yann Nguyen ◽

Pierre-Yves Boelle ◽

Vincent Dubée ◽

...

Keyword(s):

Intensive Care Unit ◽

Pulmonary Embolism ◽

Intensive Care ◽

Acute Pulmonary Embolism ◽

Tissue Perfusion

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Troponin, A Predictor of Mortality in Methadone Exposure: An Observational Prospective Study

Journal of the American Heart Association ◽

10.1161/jaha.120.018899 ◽

2021 ◽

Author(s):

Mehdi Sheibani ◽

Akram Alsadat Mirfallah Nassiri ◽

Amirhossein Abedtash ◽

Rebecca McDonald ◽

Nasim Zamani ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Cardiac Troponin ◽

Troponin I ◽

Methadone Maintenance ◽

Characteristic Curve ◽

Public Health Problem ◽

Global Public Health ◽

Cutoff Value

Background Methadone poisoning/overdose is a global public health problem. We aimed to determine whether methadone poisoning increased cardiac troponin and whether high‐sensitivity cardiac troponin I (hs‐cTnI) levels predicted the need for intensive care unit admission, intubation, and mortality. Methods and Results This observational, prospective single‐center study was done at Loghman‐Hakim Hospital (Tehran, Iran) from June 2018 until February 2019. Patients aged >14 years admitted with a diagnosis of methadone exposure were included. Patients were excluded if they had coexisting conditions associated with elevated hs‐cTnI levels. An ECG and hs‐cTnI levels were obtained on emergency department presentation. Patients were followed up on their need for intubation, intensive care unit admission, and in‐hospital mortality. Of 245 included patients (186 [75.9%] men; median age, 33 years), most referred to loss of consciousness (210 cases, 89%). Nineteen (7.7%) patients had hs‐cTnI levels of >0.1 ng/mL (positive), and 41 (16.7%) had borderline levels of 0.019 to 0.1 ng/mL. Twenty‐three (9.3%) cases were admitted to the intensive care unit, 21 (8.5%) needed intubation, and 5 (2%) died during hospitalization. An hs‐cTnI cutoff value of 0.019 ng/mL independently predicted mortality. For optimal concomitant sensitivity and specificity, receiver operating characteristic curve analysis was conducted and showed that hs‐cTnI had an independent significant association with mortality, with a cutoff value of 0.0365 ng/mL (odds ratio, 38.1; 95% CI, 2.3–641.9; P <0.001). Conclusions Methadone exposure/toxicity is a newly identified cause of elevated hs‐cTnI. Values >0.019 ng/mL, and particularly >0.0365 ng/mL, of hs‐cTnI predicted mortality in our sample. Future studies should measure troponin levels in methadone maintenance treatment clients to assess the risk of myocardial injury from long‐term exposure.

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