Prognostic significance of elevated cardiac troponin-T levels in acute respiratory distress syndrome patients

Matthew B. Rivara, Ednan K. Bajwa, James L. Januzzi, Michelle Ng Gong, B. Taylor Thompson, David C. Christiani

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Elevated levels of biochemical markers of myocardial necrosis have been associated with worsened outcomes in Acute Respiratory Distress Syndrome (ARDS), but there are few prospective data on this relationship. We investigated elevated cardiac troponin T (cTnT) levels and their relationship with outcome in patients with ARDS. Methods: A prospective cohort study of patients with ARDS was conducted at a tertiary-care academic medical center. Patients had blood taken within 48 hours of ARDS onset and assayed for cTnT. Patients were followed for the outcomes of 60-day mortality, number of organ failures, and days free of mechanical ventilation. Echocardiographic and electrocardiographic (ECG) data were analyzed for signs of myocardial ischemia, infarction, or other myocardial dysfunction. Results: 177 patients were enrolled, 70 of whom died (40%). 119 patients had detectable cTnT levels (67%). Median cTnT level was 0.03 ng/mL, IQR 0-0.10 ng/mL, and levels were higher among non-survivors (P =. 008). Increasing cTnT level was significantly associated with increasing mortality (P =. 008). The association between increasing cTnT level and mortality remained significant after adjustment in a multivariate model (HRadj = 1.45, 95% CI 1.17-1.81, P =. 001). Elevated cTnT level was also associated with increased number of organ failures (P =. 002), decreased number of days free of mechanical ventilation (P =. 03), echocardiographic wall motion abnormalities (P = 0.001), and severity of tricuspid regurgitation (P =. 04). There was no association between ECG findings of myocardial ischemia or infarction and elevated cTnT. Conclusions: Elevated cTnT levels are common in patients with ARDS, and are associated with worsened clinical outcomes and certain echocardiographic abnormalities. No association was seen between cTnT levels and ECG evidence of coronary ischemia.

Original languageEnglish (US)
Article numbere40515
JournalPLoS One
Volume7
Issue number7
DOIs
StatePublished - Jul 12 2012

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troponin T
Troponin T
Adult Respiratory Distress Syndrome
myocardial ischemia
Artificial Respiration
Myocardial Ischemia
Mortality
Myocardial Infarction
acute respiratory distress syndrome
Tricuspid Valve Insufficiency
infarction
myocardial infarction
Tertiary Healthcare
ischemia
cohort studies
Health care
biomarkers
necrosis
Blood
Cohort Studies

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Prognostic significance of elevated cardiac troponin-T levels in acute respiratory distress syndrome patients. / Rivara, Matthew B.; Bajwa, Ednan K.; Januzzi, James L.; Gong, Michelle Ng; Thompson, B. Taylor; Christiani, David C.

In: PLoS One, Vol. 7, No. 7, e40515, 12.07.2012.

Research output: Contribution to journalArticle

Rivara, Matthew B. ; Bajwa, Ednan K. ; Januzzi, James L. ; Gong, Michelle Ng ; Thompson, B. Taylor ; Christiani, David C. / Prognostic significance of elevated cardiac troponin-T levels in acute respiratory distress syndrome patients. In: PLoS One. 2012 ; Vol. 7, No. 7.
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abstract = "Background: Elevated levels of biochemical markers of myocardial necrosis have been associated with worsened outcomes in Acute Respiratory Distress Syndrome (ARDS), but there are few prospective data on this relationship. We investigated elevated cardiac troponin T (cTnT) levels and their relationship with outcome in patients with ARDS. Methods: A prospective cohort study of patients with ARDS was conducted at a tertiary-care academic medical center. Patients had blood taken within 48 hours of ARDS onset and assayed for cTnT. Patients were followed for the outcomes of 60-day mortality, number of organ failures, and days free of mechanical ventilation. Echocardiographic and electrocardiographic (ECG) data were analyzed for signs of myocardial ischemia, infarction, or other myocardial dysfunction. Results: 177 patients were enrolled, 70 of whom died (40{\%}). 119 patients had detectable cTnT levels (67{\%}). Median cTnT level was 0.03 ng/mL, IQR 0-0.10 ng/mL, and levels were higher among non-survivors (P =. 008). Increasing cTnT level was significantly associated with increasing mortality (P =. 008). The association between increasing cTnT level and mortality remained significant after adjustment in a multivariate model (HRadj = 1.45, 95{\%} CI 1.17-1.81, P =. 001). Elevated cTnT level was also associated with increased number of organ failures (P =. 002), decreased number of days free of mechanical ventilation (P =. 03), echocardiographic wall motion abnormalities (P = 0.001), and severity of tricuspid regurgitation (P =. 04). There was no association between ECG findings of myocardial ischemia or infarction and elevated cTnT. Conclusions: Elevated cTnT levels are common in patients with ARDS, and are associated with worsened clinical outcomes and certain echocardiographic abnormalities. No association was seen between cTnT levels and ECG evidence of coronary ischemia.",
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AU - Rivara, Matthew B.

AU - Bajwa, Ednan K.

AU - Januzzi, James L.

AU - Gong, Michelle Ng

AU - Thompson, B. Taylor

AU - Christiani, David C.

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N2 - Background: Elevated levels of biochemical markers of myocardial necrosis have been associated with worsened outcomes in Acute Respiratory Distress Syndrome (ARDS), but there are few prospective data on this relationship. We investigated elevated cardiac troponin T (cTnT) levels and their relationship with outcome in patients with ARDS. Methods: A prospective cohort study of patients with ARDS was conducted at a tertiary-care academic medical center. Patients had blood taken within 48 hours of ARDS onset and assayed for cTnT. Patients were followed for the outcomes of 60-day mortality, number of organ failures, and days free of mechanical ventilation. Echocardiographic and electrocardiographic (ECG) data were analyzed for signs of myocardial ischemia, infarction, or other myocardial dysfunction. Results: 177 patients were enrolled, 70 of whom died (40%). 119 patients had detectable cTnT levels (67%). Median cTnT level was 0.03 ng/mL, IQR 0-0.10 ng/mL, and levels were higher among non-survivors (P =. 008). Increasing cTnT level was significantly associated with increasing mortality (P =. 008). The association between increasing cTnT level and mortality remained significant after adjustment in a multivariate model (HRadj = 1.45, 95% CI 1.17-1.81, P =. 001). Elevated cTnT level was also associated with increased number of organ failures (P =. 002), decreased number of days free of mechanical ventilation (P =. 03), echocardiographic wall motion abnormalities (P = 0.001), and severity of tricuspid regurgitation (P =. 04). There was no association between ECG findings of myocardial ischemia or infarction and elevated cTnT. Conclusions: Elevated cTnT levels are common in patients with ARDS, and are associated with worsened clinical outcomes and certain echocardiographic abnormalities. No association was seen between cTnT levels and ECG evidence of coronary ischemia.

AB - Background: Elevated levels of biochemical markers of myocardial necrosis have been associated with worsened outcomes in Acute Respiratory Distress Syndrome (ARDS), but there are few prospective data on this relationship. We investigated elevated cardiac troponin T (cTnT) levels and their relationship with outcome in patients with ARDS. Methods: A prospective cohort study of patients with ARDS was conducted at a tertiary-care academic medical center. Patients had blood taken within 48 hours of ARDS onset and assayed for cTnT. Patients were followed for the outcomes of 60-day mortality, number of organ failures, and days free of mechanical ventilation. Echocardiographic and electrocardiographic (ECG) data were analyzed for signs of myocardial ischemia, infarction, or other myocardial dysfunction. Results: 177 patients were enrolled, 70 of whom died (40%). 119 patients had detectable cTnT levels (67%). Median cTnT level was 0.03 ng/mL, IQR 0-0.10 ng/mL, and levels were higher among non-survivors (P =. 008). Increasing cTnT level was significantly associated with increasing mortality (P =. 008). The association between increasing cTnT level and mortality remained significant after adjustment in a multivariate model (HRadj = 1.45, 95% CI 1.17-1.81, P =. 001). Elevated cTnT level was also associated with increased number of organ failures (P =. 002), decreased number of days free of mechanical ventilation (P =. 03), echocardiographic wall motion abnormalities (P = 0.001), and severity of tricuspid regurgitation (P =. 04). There was no association between ECG findings of myocardial ischemia or infarction and elevated cTnT. Conclusions: Elevated cTnT levels are common in patients with ARDS, and are associated with worsened clinical outcomes and certain echocardiographic abnormalities. No association was seen between cTnT levels and ECG evidence of coronary ischemia.

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