Elevated troponin I levels in acute liver failure

Is myocardial injury an integral part of acute liver failure?

Nimisha K. Parekh, Linda S. Hynan, James De Lemos, William M. Lee, Julie Polson, Carla Pezzia, Ezmina Lalani, Joan S. Reisch, Anne M. Larson, Hao Do, Jeffrey S. Crippin, Laura Gerstle, Timothy J. Davern, Katherine Partovi, Sukru Emre, Timothy M. McCashland, Tamara Bernard, J. Eileen Hay, Cindy Groettum, Natalie Murray & 36 others Sonnya Coultrup, A. Obaid Shakil, Diane Morton, Andres T. Blei, Jeanne Gottstein, Atif Zaman, Jonathan M. Schwartz, Ken Ingram, Steven Han, Val Peacock, Robert J. Fontana, Suzanne Welch, Brendan McGuire, Linda Avant, Raymond Chung, Deborah Casson, Robert Brown, Michael Schilsky, Laren Senkbeil, M. Edwyn Harrison, Rebecca Rush, Adrian Reuben, Nancy Huntley, Santiago Munoz, Chandra Misra, Todd Stravitz, Jennifer Salvatori, Lorenzo Rossaro, Colette Prosser, Raj Satyanarayana, Wendy Taylor, Raj Reddy, Mical Campbell, Tarek Hassenein, Fatma Barakat, Alistair Smith

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Although rare instances of cardiac injury or arrhythmias have been reported in acute liver failure (ALF), overall, the heart is considered to be spared in this condition. Troponin I, a sensitive and specific marker of myocardial injury, may be elevated in patients with sepsis and acute stroke without underlying acute coronary syndrome, indicating unrecognized cardiac injury in these settings. We sought to determine whether subclinical cardiac injury might also occur in acute liver failure. Serum troponin I levels were measured in 187 patients enrolled in the US Acute Liver Failure Study Group registry, and correlated with clinical variables and outcomes. Diagnoses were representative of the larger group of > 1000 patients thus far enrolled and included 80 with acetaminophen-related injury, 26 with viral hepatitis, 19 with ischemic injury, and 62 others. Overall, 74% of patients had elevated troponin I levels (>0.1 ng/ml). Patients with elevated troponin I levels were more likely to have advanced hepatic coma (grades III or IV) or to die (for troponin I levels >0.1 ng/ml, odds ratio 3.88 and 4.69 for advanced coma or death, respectively). Conclusion: In acute liver failure, subclinical myocardial injury appears to occur more commonly than has been recognized, and its pathogenesis in the context of acute liver failure is unclear. Elevated troponin levels are associated with a significant increase in morbidity and mortality. Measurement of troponin I levels may be helpful in patients with acute liver failure, to detect unrecognized myocardial damage and as a marker of unfavorable outcome.

Original languageEnglish (US)
Pages (from-to)1489-1495
Number of pages7
JournalHepatology
Volume45
Issue number6
DOIs
StatePublished - Jun 2007
Externally publishedYes

Fingerprint

Troponin I
Acute Liver Failure
Wounds and Injuries
Troponin
Hepatic Encephalopathy
Acute Coronary Syndrome
Acetaminophen
Coma
Hepatitis
Registries
Cardiac Arrhythmias
Sepsis
Stroke
Odds Ratio
Morbidity
Mortality
Serum

ASJC Scopus subject areas

  • Hepatology

Cite this

Parekh, N. K., Hynan, L. S., De Lemos, J., Lee, W. M., Polson, J., Pezzia, C., ... Smith, A. (2007). Elevated troponin I levels in acute liver failure: Is myocardial injury an integral part of acute liver failure? Hepatology, 45(6), 1489-1495. https://doi.org/10.1002/hep.21640

Elevated troponin I levels in acute liver failure : Is myocardial injury an integral part of acute liver failure? / Parekh, Nimisha K.; Hynan, Linda S.; De Lemos, James; Lee, William M.; Polson, Julie; Pezzia, Carla; Lalani, Ezmina; Reisch, Joan S.; Larson, Anne M.; Do, Hao; Crippin, Jeffrey S.; Gerstle, Laura; Davern, Timothy J.; Partovi, Katherine; Emre, Sukru; McCashland, Timothy M.; Bernard, Tamara; Hay, J. Eileen; Groettum, Cindy; Murray, Natalie; Coultrup, Sonnya; Shakil, A. Obaid; Morton, Diane; Blei, Andres T.; Gottstein, Jeanne; Zaman, Atif; Schwartz, Jonathan M.; Ingram, Ken; Han, Steven; Peacock, Val; Fontana, Robert J.; Welch, Suzanne; McGuire, Brendan; Avant, Linda; Chung, Raymond; Casson, Deborah; Brown, Robert; Schilsky, Michael; Senkbeil, Laren; Harrison, M. Edwyn; Rush, Rebecca; Reuben, Adrian; Huntley, Nancy; Munoz, Santiago; Misra, Chandra; Stravitz, Todd; Salvatori, Jennifer; Rossaro, Lorenzo; Prosser, Colette; Satyanarayana, Raj; Taylor, Wendy; Reddy, Raj; Campbell, Mical; Hassenein, Tarek; Barakat, Fatma; Smith, Alistair.

In: Hepatology, Vol. 45, No. 6, 06.2007, p. 1489-1495.

Research output: Contribution to journalArticle

Parekh, NK, Hynan, LS, De Lemos, J, Lee, WM, Polson, J, Pezzia, C, Lalani, E, Reisch, JS, Larson, AM, Do, H, Crippin, JS, Gerstle, L, Davern, TJ, Partovi, K, Emre, S, McCashland, TM, Bernard, T, Hay, JE, Groettum, C, Murray, N, Coultrup, S, Shakil, AO, Morton, D, Blei, AT, Gottstein, J, Zaman, A, Schwartz, JM, Ingram, K, Han, S, Peacock, V, Fontana, RJ, Welch, S, McGuire, B, Avant, L, Chung, R, Casson, D, Brown, R, Schilsky, M, Senkbeil, L, Harrison, ME, Rush, R, Reuben, A, Huntley, N, Munoz, S, Misra, C, Stravitz, T, Salvatori, J, Rossaro, L, Prosser, C, Satyanarayana, R, Taylor, W, Reddy, R, Campbell, M, Hassenein, T, Barakat, F & Smith, A 2007, 'Elevated troponin I levels in acute liver failure: Is myocardial injury an integral part of acute liver failure?', Hepatology, vol. 45, no. 6, pp. 1489-1495. https://doi.org/10.1002/hep.21640
Parekh, Nimisha K. ; Hynan, Linda S. ; De Lemos, James ; Lee, William M. ; Polson, Julie ; Pezzia, Carla ; Lalani, Ezmina ; Reisch, Joan S. ; Larson, Anne M. ; Do, Hao ; Crippin, Jeffrey S. ; Gerstle, Laura ; Davern, Timothy J. ; Partovi, Katherine ; Emre, Sukru ; McCashland, Timothy M. ; Bernard, Tamara ; Hay, J. Eileen ; Groettum, Cindy ; Murray, Natalie ; Coultrup, Sonnya ; Shakil, A. Obaid ; Morton, Diane ; Blei, Andres T. ; Gottstein, Jeanne ; Zaman, Atif ; Schwartz, Jonathan M. ; Ingram, Ken ; Han, Steven ; Peacock, Val ; Fontana, Robert J. ; Welch, Suzanne ; McGuire, Brendan ; Avant, Linda ; Chung, Raymond ; Casson, Deborah ; Brown, Robert ; Schilsky, Michael ; Senkbeil, Laren ; Harrison, M. Edwyn ; Rush, Rebecca ; Reuben, Adrian ; Huntley, Nancy ; Munoz, Santiago ; Misra, Chandra ; Stravitz, Todd ; Salvatori, Jennifer ; Rossaro, Lorenzo ; Prosser, Colette ; Satyanarayana, Raj ; Taylor, Wendy ; Reddy, Raj ; Campbell, Mical ; Hassenein, Tarek ; Barakat, Fatma ; Smith, Alistair. / Elevated troponin I levels in acute liver failure : Is myocardial injury an integral part of acute liver failure?. In: Hepatology. 2007 ; Vol. 45, No. 6. pp. 1489-1495.
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author = "Parekh, {Nimisha K.} and Hynan, {Linda S.} and {De Lemos}, James and Lee, {William M.} and Julie Polson and Carla Pezzia and Ezmina Lalani and Reisch, {Joan S.} and Larson, {Anne M.} and Hao Do and Crippin, {Jeffrey S.} and Laura Gerstle and Davern, {Timothy J.} and Katherine Partovi and Sukru Emre and McCashland, {Timothy M.} and Tamara Bernard and Hay, {J. Eileen} and Cindy Groettum and Natalie Murray and Sonnya Coultrup and Shakil, {A. Obaid} and Diane Morton and Blei, {Andres T.} and Jeanne Gottstein and Atif Zaman and Schwartz, {Jonathan M.} and Ken Ingram and Steven Han and Val Peacock and Fontana, {Robert J.} and Suzanne Welch and Brendan McGuire and Linda Avant and Raymond Chung and Deborah Casson and Robert Brown and Michael Schilsky and Laren Senkbeil and Harrison, {M. Edwyn} and Rebecca Rush and Adrian Reuben and Nancy Huntley and Santiago Munoz and Chandra Misra and Todd Stravitz and Jennifer Salvatori and Lorenzo Rossaro and Colette Prosser and Raj Satyanarayana and Wendy Taylor and Raj Reddy and Mical Campbell and Tarek Hassenein and Fatma Barakat and Alistair Smith",
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T1 - Elevated troponin I levels in acute liver failure

T2 - Is myocardial injury an integral part of acute liver failure?

AU - Parekh, Nimisha K.

AU - Hynan, Linda S.

AU - De Lemos, James

AU - Lee, William M.

AU - Polson, Julie

AU - Pezzia, Carla

AU - Lalani, Ezmina

AU - Reisch, Joan S.

AU - Larson, Anne M.

AU - Do, Hao

AU - Crippin, Jeffrey S.

AU - Gerstle, Laura

AU - Davern, Timothy J.

AU - Partovi, Katherine

AU - Emre, Sukru

AU - McCashland, Timothy M.

AU - Bernard, Tamara

AU - Hay, J. Eileen

AU - Groettum, Cindy

AU - Murray, Natalie

AU - Coultrup, Sonnya

AU - Shakil, A. Obaid

AU - Morton, Diane

AU - Blei, Andres T.

AU - Gottstein, Jeanne

AU - Zaman, Atif

AU - Schwartz, Jonathan M.

AU - Ingram, Ken

AU - Han, Steven

AU - Peacock, Val

AU - Fontana, Robert J.

AU - Welch, Suzanne

AU - McGuire, Brendan

AU - Avant, Linda

AU - Chung, Raymond

AU - Casson, Deborah

AU - Brown, Robert

AU - Schilsky, Michael

AU - Senkbeil, Laren

AU - Harrison, M. Edwyn

AU - Rush, Rebecca

AU - Reuben, Adrian

AU - Huntley, Nancy

AU - Munoz, Santiago

AU - Misra, Chandra

AU - Stravitz, Todd

AU - Salvatori, Jennifer

AU - Rossaro, Lorenzo

AU - Prosser, Colette

AU - Satyanarayana, Raj

AU - Taylor, Wendy

AU - Reddy, Raj

AU - Campbell, Mical

AU - Hassenein, Tarek

AU - Barakat, Fatma

AU - Smith, Alistair

PY - 2007/6

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N2 - Although rare instances of cardiac injury or arrhythmias have been reported in acute liver failure (ALF), overall, the heart is considered to be spared in this condition. Troponin I, a sensitive and specific marker of myocardial injury, may be elevated in patients with sepsis and acute stroke without underlying acute coronary syndrome, indicating unrecognized cardiac injury in these settings. We sought to determine whether subclinical cardiac injury might also occur in acute liver failure. Serum troponin I levels were measured in 187 patients enrolled in the US Acute Liver Failure Study Group registry, and correlated with clinical variables and outcomes. Diagnoses were representative of the larger group of > 1000 patients thus far enrolled and included 80 with acetaminophen-related injury, 26 with viral hepatitis, 19 with ischemic injury, and 62 others. Overall, 74% of patients had elevated troponin I levels (>0.1 ng/ml). Patients with elevated troponin I levels were more likely to have advanced hepatic coma (grades III or IV) or to die (for troponin I levels >0.1 ng/ml, odds ratio 3.88 and 4.69 for advanced coma or death, respectively). Conclusion: In acute liver failure, subclinical myocardial injury appears to occur more commonly than has been recognized, and its pathogenesis in the context of acute liver failure is unclear. Elevated troponin levels are associated with a significant increase in morbidity and mortality. Measurement of troponin I levels may be helpful in patients with acute liver failure, to detect unrecognized myocardial damage and as a marker of unfavorable outcome.

AB - Although rare instances of cardiac injury or arrhythmias have been reported in acute liver failure (ALF), overall, the heart is considered to be spared in this condition. Troponin I, a sensitive and specific marker of myocardial injury, may be elevated in patients with sepsis and acute stroke without underlying acute coronary syndrome, indicating unrecognized cardiac injury in these settings. We sought to determine whether subclinical cardiac injury might also occur in acute liver failure. Serum troponin I levels were measured in 187 patients enrolled in the US Acute Liver Failure Study Group registry, and correlated with clinical variables and outcomes. Diagnoses were representative of the larger group of > 1000 patients thus far enrolled and included 80 with acetaminophen-related injury, 26 with viral hepatitis, 19 with ischemic injury, and 62 others. Overall, 74% of patients had elevated troponin I levels (>0.1 ng/ml). Patients with elevated troponin I levels were more likely to have advanced hepatic coma (grades III or IV) or to die (for troponin I levels >0.1 ng/ml, odds ratio 3.88 and 4.69 for advanced coma or death, respectively). Conclusion: In acute liver failure, subclinical myocardial injury appears to occur more commonly than has been recognized, and its pathogenesis in the context of acute liver failure is unclear. Elevated troponin levels are associated with a significant increase in morbidity and mortality. Measurement of troponin I levels may be helpful in patients with acute liver failure, to detect unrecognized myocardial damage and as a marker of unfavorable outcome.

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