TY - JOUR
T1 - Long-term prognostic significance of elevated cardiac troponin levels in critically ill patients with acute gastrointestinal bleeding
AU - Vasile, Vlad C.
AU - Babuin, Luciano
AU - Perez, Jose A.Rio
AU - Alegria, Jorge R.
AU - Song, Louis M.Wong Kee
AU - Chai, High Seng
AU - Afessa, Bekele
AU - Jaffe, Allan S.
PY - 2009/1
Y1 - 2009/1
N2 - BACKGROUND:: Elevations in troponin level have prognostic importance in critically ill patients, including those with gastrointestinal (GI) bleeding. However, there are no data addressing the independent association of troponin levels and mortality, adjusted for the severity of the underlying disease, in patients with GI bleeding. OBJECTIVE:: This study was designed to determine whether troponin T elevations are independently associated with in-hospital, short-term (30 days), and long-term mortality in medical intensive care unit patients with GI bleeding after adjusting for the severity of disease measured by the Acute Physiology, Age, and Chronic Health Evaluation score prognostic system. DESIGN:: Retrospective study. SETTING:: We examined the Acute Physiology, Age, and Chronic Health Evaluation III database and cardiac troponin T levels from patients consecutively admitted to the medical intensive care unit at Mayo Clinic, Rochester, MN, with acute GI bleeding. PATIENTS:: Between August 2000 and July 2005, 1076 patients with acute GI bleeding consecutively admitted to the medical intensive care units. MEASUREMENTS:: In-hospital, short-term (30 days), and long-term all-cause mortality. RESULTS:: During hospitalization, 8.0% of deaths occurred in patients with troponin T <0.01% and 11.9% with troponin T ≥0.01 (p = 0.083). At 30 days, mortality was 10.1% and 18.8% in patients without and with elevations of troponins, respectively (p < 0.001). The Kaplan-Meier expected probability of survival at 1-, 2-, and 3-yr follow-up was 54.2%, 40.8%, and 30.4% with troponin T ≥0.01 μg/L and 78.3%, 69.3%, and 61.5% with troponin T <0.01 μg/L (p < 0.001). After adjustment for severity of disease and baseline characteristics, cardiac troponin levels were associated only with long-term mortality (p < 0.001). LIMITATIONS:: This is a retrospective, single-center study which included only patients in whom troponin level was determined upon admission. CONCLUSIONS:: In patients with GI bleeding severe enough to require admission to the medical intensive care unit, admission troponin T elevations are associated with long-term but not short-term mortality.
AB - BACKGROUND:: Elevations in troponin level have prognostic importance in critically ill patients, including those with gastrointestinal (GI) bleeding. However, there are no data addressing the independent association of troponin levels and mortality, adjusted for the severity of the underlying disease, in patients with GI bleeding. OBJECTIVE:: This study was designed to determine whether troponin T elevations are independently associated with in-hospital, short-term (30 days), and long-term mortality in medical intensive care unit patients with GI bleeding after adjusting for the severity of disease measured by the Acute Physiology, Age, and Chronic Health Evaluation score prognostic system. DESIGN:: Retrospective study. SETTING:: We examined the Acute Physiology, Age, and Chronic Health Evaluation III database and cardiac troponin T levels from patients consecutively admitted to the medical intensive care unit at Mayo Clinic, Rochester, MN, with acute GI bleeding. PATIENTS:: Between August 2000 and July 2005, 1076 patients with acute GI bleeding consecutively admitted to the medical intensive care units. MEASUREMENTS:: In-hospital, short-term (30 days), and long-term all-cause mortality. RESULTS:: During hospitalization, 8.0% of deaths occurred in patients with troponin T <0.01% and 11.9% with troponin T ≥0.01 (p = 0.083). At 30 days, mortality was 10.1% and 18.8% in patients without and with elevations of troponins, respectively (p < 0.001). The Kaplan-Meier expected probability of survival at 1-, 2-, and 3-yr follow-up was 54.2%, 40.8%, and 30.4% with troponin T ≥0.01 μg/L and 78.3%, 69.3%, and 61.5% with troponin T <0.01 μg/L (p < 0.001). After adjustment for severity of disease and baseline characteristics, cardiac troponin levels were associated only with long-term mortality (p < 0.001). LIMITATIONS:: This is a retrospective, single-center study which included only patients in whom troponin level was determined upon admission. CONCLUSIONS:: In patients with GI bleeding severe enough to require admission to the medical intensive care unit, admission troponin T elevations are associated with long-term but not short-term mortality.
KW - Cardiac injury
KW - Gastrointestinal bleeding
KW - Intensive care unit
KW - Troponin
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U2 - 10.1097/CCM.0b013e318192faa3
DO - 10.1097/CCM.0b013e318192faa3
M3 - Article
C2 - 19050617
AN - SCOPUS:59649102299
SN - 0090-3493
VL - 37
SP - 140
EP - 147
JO - Critical care medicine
JF - Critical care medicine
IS - 1
ER -