Department of Medicine, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.
J Crit Care. 2010 Jun;25(2):322-8. doi: 10.1016/j.jcrc.2009.07.002. Epub 2009 Sep 24.
The aim of this study was to assess the etiology of cardiac troponin elevation among patients admitted to the intensive care unit (ICU) and to examine whether etiology affects mortality and length of stay.
All patients admitted over 2 months underwent screening with troponin measurements and were included if 1 or more measurements were elevated. Two adjudicators retrospectively reviewed patient charts to determine the likely cause of troponin elevation.
Of 103 patient admissions, 52 (50.5%) had 1 or more elevated troponin measurements, and 49 (94.2%) had medical charts available for review. Troponin elevation was adjudicated as myocardial infarction (MI) in 53.1% of patients, sepsis in 18.4%, renal failure in 12.2%, and other causes in 16.3%. Overall ICU mortality was 16.0%; 2.0% for patients with no troponin elevation, 23.1% in patients with MI, and 39.1% in patients with troponin elevation not due to MI. Having an elevated troponin level not due to MI was significantly associated with increased hospital mortality compared with having no troponin elevation.
The most common cause of troponin elevation among critically ill patients was MI. Patients with elevated troponin had worse outcomes compared with patients without troponin elevation, and troponin elevation not due to MI was predictive of increased hospital mortality.
本研究旨在评估入住重症监护病房（ICU）患者肌钙蛋白升高的病因，并探讨病因是否影响死亡率和住院时间。
所有入住 ICU 超过 2 个月的患者均进行肌钙蛋白检测，若 1 次或多次检测结果升高则纳入研究。2 位评审员回顾性审查患者病历，以确定肌钙蛋白升高的可能病因。
103 例患者入院中，52 例（50.5%）有 1 次或多次肌钙蛋白升高，其中 49 例（94.2%）的病历可用于回顾。肌钙蛋白升高被判定为心肌梗死（MI）的患者占 53.1%，脓毒症占 18.4%，肾衰竭占 12.2%，其他原因占 16.3%。总体 ICU 死亡率为 16.0%；无肌钙蛋白升高的患者死亡率为 2.0%，MI 患者为 23.1%，非 MI 导致的肌钙蛋白升高患者为 39.1%。与无肌钙蛋白升高的患者相比，非 MI 导致的肌钙蛋白升高与住院死亡率增加显著相关。
危重症患者肌钙蛋白升高的最常见原因为 MI。与无肌钙蛋白升高的患者相比，肌钙蛋白升高的患者预后更差，而非 MI 导致的肌钙蛋白升高与住院死亡率增加相关。
