The relationship between high-sensitivity troponin taken on admission to critical care, regardless of whether there was a clinical indication for testing, and one year mortality

Hinton, J; Augustine, M; Gabara, L; Mariathas, M; Allan, R; Borca, F; Nicholas, Z; Gillett, N; Kwok, C S; Cook, P; Grocott, M P W; Mamas, M; Curzen, N

Abstract

Introduction
High-sensitivity troponin (hs-cTn) assays now form a key component of the diagnostic pathways for patients presenting to emergency medical services with chest pain. However, hs-cTn concentrations above the manufacturer-provided upper limit of normal (ULN) are now frequently reported in patients presenting with conditions not traditionally associated with type 1 myocardial infarction (T1MI). This is particularly true of severe illness states. We investigated the possible association between hs-cTn and 1 year mortality in critical care patients.

Method
Consecutive patients admitted to two adult critical care units (general critical care unit (GCCU) and neuroscience critical care unit (NCCU)) over a six month period had hs-cTnI assay performed on admission, regardless of whether there was a clinical indication, and the results nested unless a clinical request had been made. Comorbidity data, illness severity and critical care outcome were recorded and have been previously reported. One year mortality data were obtained from NHS Digital.

Results
After excluding patients diagnosed with T1MI by the clinical team, there were 1,033 patients remaining. At one year a total of 253 (24.5%) patients had died. The Kaplan-Meier curves in figure 1 demonstrate a positive association between mortality and increasing hs-cTnI concentrations relative to the ULN. Specifically, using the log-rank test, the mortality at one year was significantly higher (p<0.001) in patients with hs-cTnI concentrations above the ULN. Furthermore, on multivariable Cox regression analysis, the log(10) hs-cTnI concentration was independently associated with the hazard of one year mortality (hazard ratio 1.587 (95% confidence interval 1.358–1.856).

Conclusions
These data suggest that admission hs-cTnI is a biomarker for one year mortality in critical care patients. Further work is now required to assess whether any medical intervention can alter this risk.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Beckman Coulter provided the assays for the tests used in this study. They had no other involvement in the study

Citation

Hinton, J., Augustine, M., Gabara, L., Mariathas, M., Allan, R., Borca, F., Nicholas, Z., Gillett, N., Kwok, C. S., Cook, P., Grocott, M. P. W., Mamas, M., & Curzen, N. The relationship between high-sensitivity troponin taken on admission to critical care, regardless of whether there was a clinical indication for testing, and one year mortality. Presented at ESC Congress 2021 – The Digital Experience

• Presentation Conference Type: Conference Paper (published)
• Conference Name: ESC Congress 2021 – The Digital Experience
• Acceptance Date: Oct 14, 2021
• Online Publication Date: Oct 14, 2021
• Publication Date: Oct 12, 2021
• Deposit Date: Jun 28, 2023
• Journal: European Heart Journal
• Print ISSN: 0195-668X
• Electronic ISSN: 1522-9645
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 42
• Issue: Supplement_1
• DOI: https://doi.org/10.1093/eurheartj/ehab724.1381
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://keele-repository.worktribe.com/output/509993