Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome

Thomas S. Metkus, Eliseo Guallar, Lori Sokoll, David A. Morrow, Gordon F. Tomaselli, Roy Brower, Bo Soo Kim, Steven Schulman, Frederick K. Korley

Research output: Contribution to journalArticle

Abstract

Purpose: Myocardial injury connotes worse prognosis in the Acute Respiratory Distress Syndrome (ARDS), however the prognostic connotation of changes in cardiac troponin (cTn) levels in ARDS patients is not known. Methods: We performed a study of 908 ARDS patients enrolled in two previously completed ARDS Network trials. We obtained plasma samples via the NIH BIOLINCC repository and measured cTn using the ARCHITECT STAT high sensitivity troponin-I assay (Abbott Laboratories) at trial day 0 and 3. We constructed Cox proportional hazard models to determine the association between 60-day mortality and quintiles of percentage change in high-sensitivity troponin (ΔhsTnI). Results: The median percent change in hsTnI (%ΔhsTnI) from day 0 to day 3 was −58.2% (IQR -79.0 to 0%). After multivariable adjustment, participants with a 32.1% or greater increase in hsTnI between day 0 and day 3 (highest quintile) had a 2.27 fold increased risk for mortality (95% CI 1.29 – 3.99, p = 0.002) as well as fewer ventilator-free and ICU-free days compared to the lowest quintile. Conclusion: Progressive myocardial injury in ARDS patients is associated with worse outcome, independent of severity of critical illness. Investigation of the mechanisms underlying this relationship is warranted to guide possible strategies to mitigate myocardial injury in ARDS.

Original languageEnglish (US)
Pages (from-to)26-31
Number of pages6
JournalJournal of Critical Care
Volume48
DOIs
StatePublished - Dec 1 2018
Externally publishedYes

Fingerprint

Adult Respiratory Distress Syndrome
Troponin
Mortality
Wounds and Injuries
Troponin I
Mechanical Ventilators
Proportional Hazards Models
Critical Illness

Keywords

  • ARDS
  • Cardiac
  • Hypoxia
  • Myocardial injury
  • Troponin

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome. / Metkus, Thomas S.; Guallar, Eliseo; Sokoll, Lori; Morrow, David A.; Tomaselli, Gordon F.; Brower, Roy; Kim, Bo Soo; Schulman, Steven; Korley, Frederick K.

In: Journal of Critical Care, Vol. 48, 01.12.2018, p. 26-31.

Research output: Contribution to journalArticle

Metkus, TS, Guallar, E, Sokoll, L, Morrow, DA, Tomaselli, GF, Brower, R, Kim, BS, Schulman, S & Korley, FK 2018, 'Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome', Journal of Critical Care, vol. 48, pp. 26-31. https://doi.org/10.1016/j.jcrc.2018.08.009
Metkus, Thomas S. ; Guallar, Eliseo ; Sokoll, Lori ; Morrow, David A. ; Tomaselli, Gordon F. ; Brower, Roy ; Kim, Bo Soo ; Schulman, Steven ; Korley, Frederick K. / Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome. In: Journal of Critical Care. 2018 ; Vol. 48. pp. 26-31.
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