Yan Tao, Li Chun-sheng
Department of Emergency Medicine, Second Hospital of Chaoyang District, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2010 Mar 23;90(11):724-7.
To investigate the role of cardiac troponin I (CTN I) for predicting 28-day mortality of non-cardiogenic critically ill patients at emergency department (ED).
A total of 431 non-cardiogenic critically ill patients at ED were prospectively enrolled and blood samples obtained for CTN I measurements. A variety of laboratory variables and the Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded. At Day 28, the survival status of each patient was ascertained and the association between CTN I at presentation and mortality assessed.
Two hundred patients had elevated CTN I levels and 231 had normal levels. Compared with those with normal levels, the patients with elevated CTN I levels had a higher 28-day mortality. The CTN I concentration alone had an area under the receiver operating characteristic curve (AUC) of 0.733 for mortality prediction. The optimal CTN I cut-off point for predicting the 28-day mortality was 0.05 ng/L. By multivariate analysis, an elevated CTN I level (> 0.05 ng/L, HR 1.979, 95% CI 1.398 - 2.802, P < 0.001), a high APACHE II score (> 16, HR 4.428, 95% CI 3.019 - 6.494, P < 0.001) and hypoalbuminemia (< 25 g/L, HR 1.812, 95% CI 1.276 - 2.573, P = 0.001) were the three most important independent predictors for a shorter survival. Combination analysis showed a shorter survival in patients with a high APACHE II score plus elevated CTN I levels than those with a high APACHE II score or an elevated CTN I level alone.
An elevated serum CTN I level is a independent predictor of 28-day mortality in non-cardiogenic critically ill patients. And CTN I level and APACHE II score have an additive effect in outcome prediction.
探讨心肌肌钙蛋白I（CTN I）在预测急诊科非心源性危重症患者28天死亡率中的作用。
前瞻性纳入431例急诊科非心源性危重症患者，采集血样检测CTN I。记录各种实验室指标及急性生理与慢性健康状况评估（APACHE）II评分。在第28天，确定每位患者的生存状态，并评估就诊时CTN I与死亡率之间的关联。
200例患者CTN I水平升高，231例患者水平正常。与CTN I水平正常的患者相比，CTN I水平升高的患者28天死亡率更高。仅CTN I浓度用于死亡率预测时，受试者工作特征曲线（AUC）下面积为0.733。预测28天死亡率的最佳CTN I截断值为0.05 ng/L。多因素分析显示，CTN I水平升高（>0.05 ng/L，HR 1.979，95%CI 1.398 - 2.802，P<0.001）、APACHE II评分高（>16，HR 4.428，95%CI 3.019 - 6.494，P<0.001）和低白蛋白血症（<25 g/L，HR 1.812，95%CI 1.276 - 2.573，P = 0.001）是生存时间缩短的三个最重要独立预测因素。联合分析显示，APACHE II评分高且CTN I水平升高的患者比单独APACHE II评分高或CTN I水平升高的患者生存时间更短。
血清CTN I水平升高是预测非心源性危重症患者28天死亡率的独立因素。CTN I水平与APACHE II评分在预后预测中有相加作用。
