Quenot Jean-Pierre, Le Teuff Gwénaël, Quantin Catherine, Doise Jean-Marc, Abrahamowicz Michal, Masson David, Blettery Bernard
Emergency Intensive Care Unit, Dijon University Hospital, Dijon, France.
Chest. 2005 Oct;128(4):2758-64. doi: 10.1378/chest.128.4.2758.
To examine the relationship between myocardial injury, assessed by cardiac troponin I (cTnI) levels, and outcome in selected critically ill patients without acute coronary syndromes or cardiac dysfunction.
Prospective, observational study in the emergency ICU of a university teaching hospital.
Over a 6-month period, 217 consecutive patients admitted to the ICU were studied.
cTnI assays were performed in all patients on admission to the ICU. The incidence of myocardial injury, defined by cTnI level > 0.1 ng/mL, was 32% (69 of 217 patients). Overall mortality was 27% (58 of 217 patients). Patients with myocardial injury had a mortality rate of 51%, compared with only 16% mortality for those without myocardial injury (p < 0.001). The hospital mortality rate was highest among older patients (71 +/- 14% vs 58.5 +/- 20%, p < 0.0001) and patients with higher simplified acute physiology scale (SAPS) II score (62 +/- 25% vs 37 +/- 17%, p < 0.0001). Mechanical ventilation was associated with higher in-hospital death (50% vs 31%, for patients who died in the hospital vs those who were discharged alive; p = 0.03). Elevated blood levels of cTnI were found to be independently associated with hospital mortality, regardless of the presence of SAPS II score and mechanical ventilation, in the logistic regression analysis (odds ratio, 2.09; 95% confidence interval, 1.06 to 4.11; p = 0.01).
This study demonstrates the high frequency of myocardial injury (32%) in critically ill patients without acute coronary syndromes or cardiac dysfunction on admission to ICU. Myocardial injury is an independent determinant of hospital mortality. Assessment of myocardial injury on admission to ICU would make it possible to identify patients at increased risk of death.
通过心肌肌钙蛋白I（cTnI）水平评估心肌损伤与特定无急性冠脉综合征或心脏功能障碍的危重症患者预后之间的关系。
在一所大学教学医院的急诊重症监护病房进行的前瞻性观察性研究。
在6个月期间，对217例连续入住重症监护病房的患者进行了研究。
所有患者在入住重症监护病房时均进行了cTnI检测。cTnI水平>0.1 ng/mL定义的心肌损伤发生率为32%（217例患者中的69例）。总体死亡率为27%（217例患者中的58例）。心肌损伤患者的死亡率为51%，而无心肌损伤患者的死亡率仅为16%（p<0.001）。老年患者（71±14%对58.5±20%，p<0.0001）和简化急性生理学评分（SAPS）II得分较高的患者（62±25%对37±17%，p<0.0001）的医院死亡率最高。机械通气与较高的院内死亡率相关（院内死亡患者为50%，出院存活患者为31%；p=0.03）。在逻辑回归分析中，无论SAPS II评分和机械通气情况如何，cTnI血水平升高均与医院死亡率独立相关（比值比，2.09；95%置信区间，1.06至4.11；p=0.01）。
本研究表明，在入住重症监护病房时无急性冠脉综合征或心脏功能障碍的危重症患者中，心肌损伤的发生率较高（32%）。心肌损伤是医院死亡率的独立决定因素。在入住重症监护病房时评估心肌损伤将有助于识别死亡风险增加的患者。
