scholarly journals Association Between Elevated Cardiac Troponin Level and Clinical Outcomes in Patients with Infective Endocarditis: A Meta-Analysis

2021 ◽  
Author(s):  
Yunfei Ling ◽  
Zheng Chai ◽  
Tiange Li ◽  
Zhongze Cao ◽  
Kerun Chen ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Clinical Outcomes ◽  
Cardiac Troponin ◽  
Data Extraction ◽  
Meta Analysis ◽  
Elevated Serum ◽  
Troponin Level ◽  
Elevated Troponin ◽  
Aggressive Approach ◽  
One Year

Abstract Background: Infective endocarditis is a serious infection associated with high mortality. Timely intervention is paramount to achieve a favorable prognosis in patients with Infective endocarditis. At present, the correlation between cardiac troponin level and Infective endocarditis prognosis is not well established.Methods: Pubmed, Embase, and Cochrane databases were systematically searched for studies examining the relationship between elevated serum cardiac troponin concentration and prognosis in patients with IE. Literature screening, data extraction and quality appraisal were undertaken by two independent reviewers.Results: A total of 7 relevant studies were included in this study. Patients with elevated troponin were significantly associated with higher incidences of in-hospital mortality [OR=5.87, 95% CI (3.37,10.21)], one-year mortality [OR=3.28, 95% CI (1.01,10.62)], surgery or valve replacement [OR=2.18, 95% CI (1.36,3.51)], symptoms of central nervous system (CNS) [OR=3.28, 95% CI (1.01,10.62)], and cardiac abscesses [OR=3.28, 95% CI (1.01,10.62)]. There was no significant correlation between elevated troponin and incidence of renal failure, embolization, or cerebrovascular events in patients with Infective endocarditis.Conclusion: Elevated cardiac troponin in patients with Infective endocarditis is associated with higher risks of several adverse clinical outcomes. Therefore, these patients would warrant a more aggressive approach and early intervention in clinical management to improve prognosis.

scholarly journals Elevated troponin level as a predictor of inpatient mortality in patients with infective endocarditis in the Southeast United States

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
William Lorson ◽  
Michael P. Veve ◽  
Eric Heidel ◽  
Mahmoud A. Shorman
Keyword(s):  
Infective Endocarditis ◽  
Injection Drug Users ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Injection Drug ◽  
Care Hospital ◽  
Troponin Level ◽  
Elevated Troponin ◽  
Inpatient Mortality ◽  
Methicillin Resistant

Abstract Background Despite recent improvement in management, infective endocarditis (IE) continues to be associated with considerable risk of morbidity and mortality. Early identification of predictors of inpatient mortality is key in improving patient outcomes in IE. The aim of our study was to evaluate the role of serum troponin levels measurements as a marker of increased mortality. Methods A case-control study included adult patients with IE admitted to a tertiary care hospital in east Tennessee between December 2012 and July 2017. Cases were defined as patients with definitive IE who died in-hospital; controls were patients who did not die in hospital. First patient admission was included only. Data collected included the patients’ demographic and baseline clinical information, microbiological data, injection drug use status, elevated serum troponins levels. Results Two hundred eighty three patients with definitive IE were included; median (IQR) age was 41 (30–57) years, and 153 (54%) patients were men. One-hundred sixty-four (58%) were injection drug users. The most frequent IE type was: 167 (59%) right-sided, 86 (30%) left-sided, 24 (9%) both left and right-sided, and 10 (4%) device related. The most commonly isolated organism was Staphylococcus aureus (n = 141), and 64% were methicillin-resistant. Two-hundred twelve (75%) patients had a troponin level obtained, and 57 (27%) had an elevated troponin value. Thirty-six (13%) patients died in-hospital; in-hospital mortality was associated elevated troponin values (adjusted odds ratio [adjOR], 7.3; 95%CI, 3.3–15.9), and methicillin-resistant S. aureus IE (adjOR 2.6; 95%CI, 1.2–5.8). Forty-four (16%) patients received IE valve surgery, and none of these patients died in the hospital. Conclusion Inpatient mortality was higher in patients with IE and elevated cardiac troponin levels compared to patients with normal levels.

Elevated Cardiac Troponin Levels in Critically Ill Patients: Prevalence, Incidence, and Outcomes

2006 ◽  
Vol 15 (3) ◽  
pp. 280-288 ◽  
Author(s):  
Wendy Lim ◽  
Deborah J. Cook ◽  
Lauren E. Griffith ◽  
Mark A. Crowther ◽  
P. J. Devereaux
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Troponin Level ◽  
Elevated Troponin ◽  
Electrocardiographic Changes

• Background Levels of cardiac troponin, a sensitive and specific marker of myocardial injury, are often elevated in critically ill patients. • Objectives To document elevated levels of cardiac troponin I in patients in a medical-surgical intensive care unit and the relationship between elevated levels and electrocardiographic findings and mortality. • Methods A total of 198 patients expected to remain in the intensive care unit for at least 72 hours were classified as having myocardial infarction (cardiac troponin I level ≥1.2 μg/L and ischemic electrocardiographic changes), elevated troponin level only (≥1.2 μg/L and no ischemic electrocardiographic changes), or normal troponin levels. Events were classified as prevalent if they occurred within 48 hours after admission and as incident if they occurred 48 hours or later after admission. Factors associated with mortality were examined by using regression analysis. • Results A total of 171 patients had at least one troponin level measured in the first 48 hours. The prevalence of elevated troponin level was 42.1% (72 patients); 38 patients (22.2%) had myocardial infarction, and 34 (19.9%) had elevated troponin level only. After the first 48 hours, 136 patients had at least 1 troponin measurement. The incidence of elevated troponin level was 11.8% (16 patients); 7 patients (5.1%) met criteria for myocardial infarction, and 2 (1.5%) had elevated troponin level only. Elevated levels of troponin I at any time during admission were associated with mortality in the univariate but not the multivariate analysis. • Conclusions Elevated levels of cardiac troponin I in critically ill patients do not always indicate myocardial infarction or an adverse prognosis.

scholarly journals Are Fluoroquinolones or Macrolides Better for Treating Legionella Pneumonia? A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Annie S Jasper ◽  
Jackson S Musuuza ◽  
Jessica S Tischendorf ◽  
Vanessa W Stevens ◽  
Shantini D Gamage ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Clinical Cure ◽  
Data Extraction ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Legionella Pneumonia ◽  
Risk Of Mortality ◽  
Cure Time ◽  
The Mean

Abstract Background The Infectious Diseases Society of America recommends either a fluoroquinolone or a macrolide as a first-line antibiotic treatment for Legionella pneumonia, but it is unclear which antibiotic leads to optimal clinical outcomes. We compared the effectiveness of fluoroquinolone versus macrolide monotherapy in Legionella pneumonia using a systematic review and meta-analysis. Methods We conducted a systematic search of literature in PubMed, Cochrane, Scopus, and Web of Science from inception to 1 June 2019. Randomized controlled trials and observational studies comparing macrolide with fluoroquinolone monotherapy using clinical outcomes in patients with Legionella pneumonia were included. Twenty-one publications out of an initial 2073 unique records met the selection criteria. Following PRISMA guidelines, 2 reviewers participated in data extraction. The primary outcome was mortality. Secondary outcomes included clinical cure, time to apyrexia, length of hospital stay (LOS), and the occurrence of complications. The review and meta-analysis was registered with PROSPERO (CRD42019132901). Results Twenty-one publications with 3525 patients met inclusion criteria. The mean age of the population was 60.9 years and 67.2% were men. The mortality rate for patients treated with fluoroquinolones was 6.9% (104/1512) compared with 7.4% (133/1790) among those treated with macrolides. The pooled odds ratio assessing risk of mortality for patients treated with fluoroquinolones versus macrolides was 0.94 (95% confidence interval, .71–1.25, I2 = 0%, P = .661). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ for patients treated with fluoroquinolones versus macrolides. Conclusions We found no difference in the effectiveness of fluoroquinolones versus macrolides in reducing mortality among patients with Legionella pneumonia.

Correlation of cardiac troponin I levels with infective endocarditis & its adverse clinical outcomes

2016 ◽  
Vol 222 ◽  
pp. 661-664 ◽  
Author(s):  
Zubair Ahmed Thoker ◽  
Khursheed Aslam Khan ◽  
Imtiyaz Rashid ◽  
Zafar
Keyword(s):  
Infective Endocarditis ◽  
Clinical Outcomes ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I

scholarly journals The short- to midterm effectiveness of stemless prostheses compared to stemmed prostheses for patients who underwent total shoulder arthroplasty: a meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Wei Peng ◽  
Yufu Ou ◽  
Chenglong Wang ◽  
Jianxun Wei ◽  
Xiaoping Mu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Clinical Decision Making ◽  
Constant Score ◽  
Data Extraction ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
Clinical Decision ◽  
Clinical Results ◽  
Cochrane Library

Abstract Background To systematically compare the short- to midterm effectiveness of stemless prostheses to that of stemmed prostheses for patients who underwent total shoulder arthroplasty (TSA) and to provide a guideline for clinical decision-making. Methods PubMed, the Cochrane Library, and Web of Science were searched with the given search terms until July 2019 to identify published articles evaluating the clinical outcomes for stemless prostheses compared with stemmed prostheses for patients who underwent TSA. Data extraction and the quality assessment of the included studies were independently performed by two authors. Stata software 14.0 was used to analyze and synthesize the data. Results Two randomized controlled trials and six case-controlled studies with a total of 347 shoulders were included in this meta-analysis. The results of this meta-analysis showed that there were no significant differences between the stemless and stemmed prostheses in terms of the Constant score, pain score, strength, activities of daily living, postoperative range of motion (ROM), and postoperative maximum active ROM. Conclusions This is the first meta-analysis reporting the clinical results of stemless TSA in the short- to midterm follow-up period. Both types of shoulder prostheses were similar in achieving satisfactory clinical outcomes.

scholarly journals Clinical Progress Notes: Updates from the 4th Universal Definition of Myocardial Infarction

2019 ◽  
Vol 14 (9) ◽  
Author(s):  
Christopher J King ◽  
Andrew E Levy ◽  
Jeffrey C Trost
Keyword(s):  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Elevated Serum ◽  
Critical Issue ◽  
Elevated Troponin ◽  
Progress Notes ◽  
Universal Definition ◽  
Definition Of ◽  
Serum Cardiac Troponin

In this clinical practice update, we aim to review the updated definition of Type 2 MI (T2MI) and nonischemic myocardial injury (NIMI), since these are the two predominant diagnoses among patients with elevated troponin in the absence of T1MI. We also provide a clinical framework for clinicians to think through elevated serum cardiac troponin levels and identify opportunities for quality improvement around this critical issue.

Early functional rehabilitation compared with traditional immobilization for acute Achilles tendon ruptures

2021 ◽  
Vol 103-B (6) ◽  
pp. 1021-1030 ◽  
Author(s):  
Xuan Liu ◽  
Tian-Jiao Dai ◽  
Bao-Lin Li ◽  
Chen Li ◽  
Zhou-Yuan Zheng ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Data Extraction ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Nonoperative Treatment ◽  
Cochrane Library ◽  
Functional Rehabilitation ◽  
Tendon Ruptures ◽  
Mean Differences ◽  
One Year

Aims The aim of this meta-analysis was to assess the prognosis after early functional rehabilitation or traditional immobilization in patients who underwent operative or nonoperative treatment for rupture of the Achilles tendon. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched for randomized controlled trials (RCTs) from their inception to 3 June 2020, using keywords related to rupture of the Achilles tendon and rehabilitation. Data extraction was undertaken by independent reviewers and subgroup analyses were performed based on the form of treatment. Risk ratios (RRs) and weighted mean differences (WMDs) (with 95% confidence intervals (CIs)) were used as summary association measures. Results We included 19 trials with a total of 1,758 patients. There was no difference between the re-rupture rate (RR 0.84 (95% CI 0.56 to 1.28); p = 0.423), time to return to work (WMD -1.29 (95% CI -2.63 to 0.05); p = 0.060), and sporting activity (WMD -1.50 (95% CI -4.36 to 1.37); p = 0.306) between the early functional rehabilitation and the traditional immobilization treatment strategies. Early rehabilitation up to 12 weeks yielded significantly better Achilles tendon Total Rupture Scores ((ATRS) WMD 5.11 (95% CI 2.10 to 8.12); p < 0.001). Patients who underwent functional rehabilitation had significantly lower limb symmetry index of heel-rise work ((HRW) WMD -4.19 (95% CI -8.20 to 0.17); p = 0.041) at one year. Conclusion Early functional rehabilitation is safe and provides better early function and the same functional outcome in the longer term. Cite this article: Bone Joint J 2021;103-B(6):1021–1030.

scholarly journals Factors Associated with Medicine Timing Effects: A Meta-analysis

2021 ◽  
Author(s):  
Marc D Ruben ◽  
Lauren J Francey ◽  
Gang Wu ◽  
David F Smith ◽  
Garret A Fitzgerald ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Day Treatment ◽  
Data Extraction ◽  
Meta Analysis ◽  
Clinical Care ◽  
Time Of Day ◽  
Outcome Data ◽  
Surgical Interventions ◽  
Timing Effect ◽  
Timing Effects

Importance Clinical evidence suggests that the time of day of treatment can affect outcomes in many different diseases, but this information is dispersed, imprecise, and heterogeneous. Consequently, practice guidelines and clinical care recommendations seldom specify intervention time. Objective To understand the sources of variability and summarize clinical findings on the time of day effects of medicine. Data Sources A systematic search of Pubmed, Google Scholar, and ClinicalTrials.gov for chronotherapy OR time of administration. Study Selection Any clinical study since 2000, randomized or observational, that compared the effects of treatment at different times of day. We included pharmacologic or surgical interventions having at least one continuous outcome. Data Extraction and Synthesis For selected studies, we extracted the mean and variance of each time-of-day treatment group. From these, we computed the standardized mean difference (SMD) as the measure of timing effect. Where a study reported multiple outcomes, we selected a single outcome based on a defined order of priority. Main Outcomes and Measures We estimated overall pooled effect size and heterogeneity by a random effects model, followed by outlier detection and subgroup analyses to evaluate how study factors, including drug, design, outcome, and source, associate with timing effect. Results 78 studies met the inclusion criteria, comprising 48 distinct interventions over many therapeutic areas. We found an overall effect of time on clinical outcomes but with substantial heterogeneity between studies. Predicted effects range from none to large depending on the study context. Study size, registration status, and source are associated with the magnitude of effect. Larger trials and those that were pre-registered have markedly smaller effects, suggesting that the published record overstates the effects of the timing of medicine on clinical outcomes. In particular, the notion that antihypertensives are more effective if taken at bedtime draws disproportionately from one source in the field, which consistently detects larger effects than the community average. Lastly, among the most highly studied drug timing relationships, the aspirin anti-clotting effect stands out, consistently favoring evening over morning dosing. Conclusions and Relevance While accounts of drug timing effects have focused on yes/no, appreciating the range of probable effects may help clarify where circadian medicine meets the threshold for clinical benefit.

scholarly journals Cardiac troponin and infective endocarditis prognosis: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Andrea Postigo ◽  
Robin W M Vernooij ◽  
Francisco Fernández-Avilés ◽  
Manuel Martínez- Sellés
Keyword(s):  
Infective Endocarditis ◽  
Cardiac Troponin ◽  
Poor Prognosis ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Cochrane Central Register ◽  
Qualitative Synthesis ◽  
Mortality And Morbidity

Abstract Aims Infective endocarditis (IE) is associated with high mortality and morbidity. Cardiac troponin (Tn) elevation seems to be common in patients with IE and could be associated with a poor prognosis. The aim of this study was to synthesize the prognostic value of Tn in patients with IE. Methods and results We searched in MEDLINE, EMBASE, and the Cochrane library, including the Cochrane Central Register of Controlled Trials (CENTRAL) until February 2020. Observational studies reporting on the association between Tn and in-hospital and 1-year mortality, and IE complications were considered eligible. As each centre uses different conventional or ultra-sensitive Tn, with different normality threshold, we considered them as normal or elevated according to the criteria specified in each article. Articles were systematically selected, assessed for bias, and, when possible, meta-analysed using a random effect model. After retrieving 542 articles, 18 were included for qualitative synthesis and 9 for quantitative meta-analysis. Compared with patients with normal Tn levels, patients with Tn elevation presented higher in-hospital mortality [odds ratio (OR) 5.96, 95% confidence interval (CI) 3.46–10.26; P &lt; 0.0001], 1-year mortality (OR 2.67, 95% CI 1.42–5.02; P = 0.002), and surgery rates (OR 2.34, 95% CI 1.42–3.85; P = 0.0008). They also suffered more frequent complications: central nervous system events (OR 8.85, 95% CI 3.23–24.26; P &lt; 0.0001) and cardiac abscesses (OR 4.96, 95% CI 1.94–12.70; P = 0.0008). Conclusion Tn elevation is associated with a poor prognosis in patients with IE. Troponin determination seems to provide additional help in the prognostic assessment of these patients.

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