The aim of our study is to determine the short-term and long-term outcomes of intensive care unit (ICU) patients with minor troponin elevations. The retrospective study compared ICU patients with peak troponin elevation less than 0.1 ng/ml to those with only negative tests during their hospital stay. Data were gathered from ICUs at Beth Israel Deaconess Medical Center between 2001 and 2008. A total of 4224 patients (2547 controls and 1677 positives) were analysed. The primary outcome was mortality at one year. Secondary outcomes were 30-day mortality and hospital and ICU lengths of stay. After adjusting for age, sex, Simplified Acute Physiology Score, Sequential Organ Failure Assessment and combined Elixhauser score, we found that minor troponin elevations (peak troponin elevation between 0.01 and 0.09 ng/ml) were associated with a higher one-year mortality (Hazard Ratio 1.22, P <0.001 for binary troponin presence; Hazard Ratio 1.03, P <0.001 for each 0.01 ng/ml troponin increment). This relationship held for the subgroup of seven-day post-discharge survivors (Hazard Ratio 1.26, P <0.001). Minor elevations of troponin also significantly increased the net reclassification index over traditional risk markers for mortality prediction (net reclassification score 0.12, P <0.001). Minor troponin elevation was also associated with 30-day mortality (odds ratio 1.33, P=0.003). Importantly, troponin testing did not increase the adjusted mortality odds (P=0.9). Minor elevations in troponin substantially increase one-year, all-cause mortality in a stepwise fashion; it was also independently associated with 30-day mortality. We propose that minor elevations in troponin should not be regarded as clinically unimportant, but rather be included as a prognostic element if measured. We recommend prospective ICU studies to assess prognostic value of routine troponin determination.
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机译：我们研究的目的是确定肌钙蛋白轻度升高的重症监护病房（ICU）患者的短期和长期结果。回顾性研究比较了肌钙蛋白峰值升高低于0.1 ng / ml的ICU患者与住院期间仅阴性检测的ICU患者。数据收集自2001年至2008年间位于贝丝以色列女执事医疗中心的ICU。共分析了4224例患者（2547例对照和1677例阳性）。主要结局是一年的死亡率。次要结果为30天死亡率以及住院和ICU住院时间。在调整了年龄，性别，简化的急性生理学评分，顺序器官衰竭评估以及综合性Elixhauser评分后，我们发现肌钙蛋白的轻微升高（峰值肌钙蛋白的升高介于0.01和0.09 ng / ml之间）与较高的一年死亡率相关（危险）二进制肌钙蛋白存在的比例为1.22，P <0.001;肌钙蛋白每增加0.01 ng / ml，危害比1.03，P <0.001）。这种关系适用于出院后7天的亚组（危险比1.26，P <0.001）。肌钙蛋白的轻微升高也显着提高了净重分类指数，超过了用于预测死亡率的传统风险指标（净重分类得分0.12，P <0.001）。肌钙蛋白轻度升高也与30天死亡率相关（赔率比1.33，P = 0.003）。重要的是，肌钙蛋白测试并未增加调整后的死亡率（P = 0.9）。肌钙蛋白的轻微升高会逐步增加一年期全因死亡率;它也独立地与30天死亡率相关。我们建议肌钙蛋白的轻微升高不应被认为在临床上不重要，而如果进行测量则应被视为预后因素。我们建议进行前瞻性ICU研究，以评估常规肌钙蛋白测定的预后价值。
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