PURPOSE: Troponin elevation can occur in critically ill patients without acute coronary syndrome (ACS) possibly due to cytosolic troponin release from increased membrane permeability. The aim of this study was to analyze the cardiac troponin I (cTnI) release pattern in non-ACS critically ill patients.
METHODS: A retrospective study of all non-ACS patients admitted to the medical intensive care unit from Jan’03 to Dec’03 with elevated serum cTnI and 3 serial measurements within 48 hours of admission was performed.
RESULTS: Of 1040 admissions, 50 patients met the inclusion criteria. The mean age and Acute Physiology And Chronic Health Evaluation (APACHE) II score were 58.8±19.2 years and 19±7.6 respectively. 50% were males. Thirty-nine (78%) patients had a transient rise followed by a fall in their cTnI levels within the first 48 hours (Figure 1) whereas eleven (22%) patients had a persistent elevation of their cTnI levels. In-hospital mortality was lower in patients with transient rise and fall (20%) compared to those with a persistent elevation (45%).
CONCLUSION: The predominant pattern of cTnI release in non-ACS critically ill patients is a transient rise and early fall of cTnI within 48 hours. The mortality in patients with this pattern is lower than patients with a persistent cTnI elevation.
CLINICAL IMPLICATIONS: Pattern of cTnI release may serve as a better predictor of mortality than a single value in critically ill patients with non ACS cTnI increase.
DISCLOSURE: Saurabh Rastogi, None.