scholarly journals Prognostic Value of High-sensitivity Cardiac Troponin in Non-cardiac Surgical Patients in Intensive Care Units

2021 ◽  
Author(s):  
Jitain Sivarajah ◽  
Michael Toolis ◽  
Samantha Seminoff ◽  
Jesse Smith ◽  
Vikram Bhalla ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Myocardial Injury ◽  
High Sensitivity ◽  
Surgical Patients ◽  
Type Ii ◽  
Icu Admission ◽  
Increased Risk

Abstract Background: Type II myocardial injury following surgical procedures is associated with adverse outcomes. The prognostic value of prognostic value of high-sensitivity cardiac troponin (hs-cTn) due to type II myocardial injury in surgical patients admitted to intensive care unit (ICU) remains unclear. The aim of this study was to assess prognostic value of hs-cTn in type II acute myocardial injury in noncardiac surgical patients requiring post-operative ICU admission.Methods: Retrospective analysis of patients admitted to two level III ICUs following surgery and had hs-cTn measured on the day of ICU admission. Patients who had type I acute myocardial infarction (AMI) during their admission were excluded from the study. The primary outcome was hospital mortality. Secondary outcomes included ICU mortality, ICU length of stay (LOS) and hospital LOS.Results: A total of 420 patients were included. On univariable analysis, higher hs-cTn was associated with increased hospital mortality (14.6% vs 6.3%, p = 0.008), ICU LOS (41.1, vs 25 hours, p = 0.004) and hospital LOS (253 hours vs 193 hours, p = 0.02). On multivariable analysis, hs-cTn was not independently associated with increased risk of hospital mortality. However, in patients who had elective surgery, hs-cTn was associated with increased risk (OR 1.048; 95% CI 1.004-1.094; p = 0.031) of hospital morality with area under the receiver operating characteristic curves of 0.753 (95% CI 0.598- 0.908).Conclusions: In elective surgical patients, hs-cTn was associated with increased risk of mortality. Larger multicentre studies are required to confirm this association that may assist in risk stratification of elective surgical patients requiring ICU admission.

scholarly journals 395. Early Predictors of Intensive Care Unit Admission among COVID-19 Patients in Qatar

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S299-S299
Author(s):  
Safae Abuyousef ◽  
Shaikha Alnaimi ◽  
Nabil E Omar ◽  
Reem Elajez ◽  
Eman Zeyad Ibrahim Elmekaty ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Medical Intervention ◽  
Icu Admission ◽  
Reactive Protein ◽  
Early Predictors ◽  
Increased Risk ◽  
Patients At Risk ◽  
And Gender

Abstract Background Coronavirus disease (COVID-19) is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission and in-hospital mortality among patients diagnosed with COVID-19. Methods This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29 - May 29, 2020. For each case enrolled, one control was matched by age and gender. Results A total of 1560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (CVD) (adjusted odds ratio (aOR)=1.64, 95% confidence interval (CI): 1.16 - 2.32, p=0.005), diabetes (aOR=1.52, 95% CI: 1.08 - 2.13, p= 0.016), obesity (aOR=1.46, 95% CI: 1.03-2.08, p= 0.034), lymphopenia (aOR=2.69, 95% CI: 1.80-4.02, p< 0.001), high aspartate aminotransferase (AST) (aOR= 2.59, 95% CI: 1.53-4.36, p< 0.001), high ferritin (aOR=1.96, 95% CI: 1.40-2.74, p< 0.001), high C-reactive protein (CRP) (aOR=4.09, 95% CI: 2.81-5.96, p< 0.001), and dyspnea (aOR=2.50, 95% CI: 1.77-3.54, p< 0.001). Similarly, significant predictors of mortality included CVD (aOR=2.16, 95% CI: 1.32- 3.53, p=0.002), diabetes (aOR=1.77, 95% CI: 1.07-2.90, p=0.025), cancer (aOR=4.65, 95% CI: 1.50-14.42, p= 0.008), lymphopenia (aOR=2.34, 95% CI: 1.45-3.78, p= 0.001), and high AST (aOR= 1.89, 95% CI: 1.04-3.43, p=0.036). Risk Factors for ICU admission among patients with COVID-19 (N=1560) Conclusion Having CVD, diabetes, lymphopenia, and increased AST were independent predictors for both ICU admission and in-hospital mortality in patients with COVID-19. In addition, obesity, high ferritin, and CRP levels were associated with increased risk of ICU admission, while cancer was strongly associated with in-hospital mortality. Early identification and monitoring of patients at risk is essential in planning the level of care needed to prevent delay in medical intervention. Disclosures Adel Abou-Ali, PharmD, PhD, Astellas Pharma Global Development, Inc. (Employee)

scholarly journals Misclassification of Myocardial Injury by a High-Sensitivity Cardiac Troponin I Assay

2021 ◽  
Author(s):  
Peter A. Kavsak ◽  
Shawn Mondoux ◽  
Andrew Worster ◽  
Janet Martin ◽  
Vikas Tandon ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
High Sensitivity ◽  
Cardiac Troponin I

scholarly journals Longitudinal obesity exposure over two decades is associated with subclinical myocardial injury: the Nord-Trondelag Health Study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.N Lyngbakken ◽  
H Rosjo ◽  
K Hveem ◽  
T Omland
Keyword(s):  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
Linear Increase ◽  
Normal Weight ◽  
Public Institution ◽  
Health Study ◽  
Funding Source ◽  
Study Visit ◽  
Increased Risk

Abstract Background Obesity is associated with subclinical myocardial injury as quantified by concentrations of cardiac troponin, but whether excess weight history is associated with increased cardiac troponin I (cTnI) remains unclear. We aimed to explore the association of obesity with cTnI using different indices of cumulative obesity exposure. Methods We analyzed cTnI with a high-sensitivity assay in 14,157 participants with follow-up over two decades in the prospective observational Nord-Trøndelag Health (HUNT) Study at study visit 4 (2017–2019). All subjects were free from known cardiovascular disease at baseline, and we excluded subjects with BMI <18.5 kg/m2. BMI was assessed at study visit 2 (1995–1997), 3 (2006–2008) and 4, and we categorized participants as normal weight (BMI <25), overweight (BMI ≥25 to <30) and obesity (BMI ≥30). At each study visit, BMI was designated a score of 0 (normal weight), 1 (overweight) or 2 (obesity), totaling a score from 0 to 6. Cumulative obesity exposure was calculated as average BMI above 25 kg/m2 between visits multiplied by the time between visits (excess BMI years, kg/m2 × years). Results Median age at visit 4 was 64.1 (range 40.9 to 101.5) years and 60% were women. Concentrations of cTnI were detectable in 77.2% of study participants, and were median 2.2 (1.3 to 3.9) ng/L. There was a linear increase in cTnI with increasing BMI score (p for trend <0.001) and increasing BMI score was associated with increased risk of high cTnI (p for trend <0.001; Table 1). For every 100 excess BMI years, there was a 15.6 (95% CI, 13.0 to 18.2) % increase in cTnI at study visit 4 (Figure 1). Conclusion Cumulative obesity exposure is associated with a linear increase in cTnI, a highly sensitive index of subclinical myocardial injury, reflecting the detrimental effect of long standing obesity on cardiovascular health. Figure 1. BMI years and cTnI Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority

scholarly journals Respiratory events in ward are associated with later intensive care unit (ICU) admission and hospital mortality in onco-hematology patients not admitted to ICU after a first request

PLoS ONE ◽  
2017 ◽  
Vol 12 (7) ◽  
pp. e0181808 ◽  
Author(s):  
Laure Doukhan ◽  
Magali Bisbal ◽  
Laurent Chow-Chine ◽  
Antoine Sannini ◽  
Jean Paul Brun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Icu Admission ◽  
Respiratory Events

High Incidence of Myocardial Ischemia during Postpartum Hemorrhage

2004 ◽  
Vol 100 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Peter C. J. Karpati ◽  
Mathias Rossignol ◽  
Marcus Pirot ◽  
Bernard Cholley ◽  
Eric Vicaut ◽  
...  
Keyword(s):  
Intensive Care ◽  
Myocardial Ischemia ◽  
Hemorrhagic Shock ◽  
Postpartum Hemorrhage ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
Elevated Serum ◽  
Cardiac Troponin I ◽  
Arterial Blood

Background Postpartum hemorrhage remains a major cause of global maternal morbidity and mortality, even in developed countries, despite the use of intensive care units. This study sought to (1) assess whether myocardial ischemia could be associated with and even aggravate hemorrhagic shock in young parturients admitted for postpartum hemorrhage, and (2) identify the independent risk factors for myocardial ischemia. Methods On their referral to the intensive care unit, a multidisciplinary team managed parturients with severe postpartum hemorrhage. Ventilation, transfusion, catecholamines, surgery, or angiography with uterine embolization were provided as clinically indicated. Plasma cardiac troponin I levels were used as a surrogate marker of acute myocardial injury and electrocardiograms of myocardial ischemia. Results A total of 55 parturients were referred with severe postpartum hemorrhage, all in hemorrhagic shock. Twenty-eight parturients (51%) had elevated serum levels of cardiac troponin I (9.4 microg/l [3.7-26.6 microg/l]), which were associated with electrocardiographic signs of ischemia and deteriorated myocardial contractility and correlated with the severity of hemorrhagic shock. Indeed, multivariate analysis identified low systolic and diastolic arterial blood pressure (< 88 and < 50 mmHg, respectively) and increased heart rate (> 115 beats/min) as independent predictors of myocardial injury. In addition, all patients who were given catecholamines also had elevated cardiac troponin I levels. Conclusions These results suggest that treatment of postpartum hemorrhage-induced hemorrhagic shock should be coupled with concomitant prevention of myocardial ischemia, even in young parturients.

scholarly journals Cardiac adipose tissue volume and IL-6 level at admission are complementary predictors of severity and short-term mortality in COVID-19 diabetic patients

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Franck Phan ◽  
Samia Boussouar ◽  
Olivier Lucidarme ◽  
Mohamed Zarai ◽  
Joe-Elie Salem ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Intensive Care ◽  
Interleukin 6 ◽  
Type Ii Diabetes ◽  
Troponin T ◽  
Early Mortality ◽  
Diabetic Patients ◽  
Type Ii ◽  
Short Term ◽  
Increased Risk

Abstract Background COVID-19 diabetic adults are at increased risk of severe forms irrespective of obesity. In patients with type-II diabetes, fat distribution is characterized by visceral and ectopic adipose tissues expansion, resulting in systemic inflammation, which may play a role in driving the COVID-19 cytokine storm. Our aim was to determine if cardiac adipose tissue, combined to interleukin-6 levels, could predict adverse short-term outcomes, death and ICU requirement, in COVID-19 diabetic patients during the 21 days after admission. Methods Eighty one consecutive patients with type-II diabetes admitted for COVID-19 were included. Interleukin-6 measurement and chest computed tomography with total cardiac adipose tissue index (CATi) measurement were performed at admission. The primary outcome was death during the 21 days following admission while intensive care requirement with or without early death (ICU-R) defined the secondary endpoint. Associations of CATi and IL-6 and threshold values to predict the primary and secondary endpoints were determined. Results Of the enrolled patients (median age 66 years [IQR: 59–74]), 73% male, median body mass index (BMI) 27 kg/m2 [IQR: 24–31]) 20 patients had died from COVID-19, 20 required intensive care and 41 were in conventional care at day 21 after admission. Increased CATi and IL-6 levels were both significantly related to increased early mortality (respectively OR = 6.15, p = 0.002; OR = 18.2, p < 0.0001) and ICU-R (respectively OR = 3.27, p = 0.01; OR = 4.86, p = 0.002). These associations remained significant independently of age, sex, BMI as well as troponin-T level and pulmonary lesion extension in CT. We combined CATi and IL-6 levels as a multiplicative interaction score (CATi*IL-6). The cut-point for this score was ≥ 6386 with a sensitivity of 0.90 and a specificity of 0.87 (AUC = 0.88) and an OR of 59.6 for early mortality (p < 0.0001). Conclusions Cardiac adipose tissue index and IL-6 determination at admission could help physicians to better identify diabetic patients with a potentially severe and lethal short term course irrespective of obesity. Diabetic patients with high CATi at admission, a fortiori associated with high IL-6 levels could be a relevant target population to promptly initiate anti-inflammatory therapies.

scholarly journals Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide and High-Sensitivity Troponin T Levels in the Natural History of Transthyretin Amyloid Cardiomyopathy and Their Evolution after Tafamidis Treatment

2021 ◽  
Vol 10 (21) ◽  
pp. 4868
Author(s):  
Silvia Oghina ◽  
Constant Josse ◽  
Mélanie Bézard ◽  
Mounira Kharoubi ◽  
Marc-Antoine Delbarre ◽  
...  
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Prognostic Value ◽  
Troponin T ◽  
High Sensitivity ◽  
Relative Increase ◽  
High Sensitivity Troponin ◽  
Increased Risk ◽  
Amyloid Cardiomyopathy ◽  
High Sensitivity Troponin T

Background: We assesse the evolution and prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (cTnT-HS) in transthyretin amyloid cardiomyopathy (ATTR-CA) before and after tafamidis treatment. Methods and Results: 454 ATTR-CA patients without tafamidis (Cohort A) and 248 ATTR-CA with tafamidis (Cohort B) were enrolled. Event-free survival (EFS) events were death, heart transplant, or acute heart failure. In Cohort A, 27% of patients maintained NT-proBNP < 3000 ng/L and 14% cTnT-HS < 50 ng/L at 12 months relative to baseline levels. In Cohort B, the proportions were 49% and 29%, respectively. In Cohort A, among the 333 patients without an increased NT-proBNP > 50% relative to baseline EFS was extended compared to the 121 patients with an increased NT-proBNP > 50% (HR: 0.75 [0.57; 0.98]; p = 0.032). In Cohort A, baseline NT-proBNP > 3000 ng/L and cTnT-HS > 50 ng/L and a relative increase of NT-proBNP > 50% during follow-up were independent prognostic factors of EFS. The slopes of logs NT-proBNP and cTnT-HS increased with time before and stabilized after tafamidis. Conclusion: ATTR-CA patients with increasing NT-proBNP had an increased risk of EFS. Tafamidis stabilize NT-proBNP and cTnT-HS increasing, even if initial NT-proBNP levels were >3000 ng/L. Thus suggesting that all patients, irrespective of baseline NT-proBNP levels, may benefit from tafamidis.

Diagnostic and Prognostic Value of High-sensitivity Cardiac Troponin T in Patients with Syncope

2015 ◽  
Vol 128 (2) ◽  
pp. 161-170.e1 ◽  
Author(s):  
Michael Christ ◽  
Felicitas Geier ◽  
Steffen Popp ◽  
Katrin Singler ◽  
Alexander Smolarsky ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Troponin T ◽  
Diagnostic And Prognostic Value
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