危重症急性呼吸疾病患者中心脏肌钙蛋白 T 水平升高的意义。

Significance of elevated cardiac troponin T levels in critically ill patients with acute respiratory disease.

机构信息

Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.

出版信息

Am J Med. 2010 Nov;123(11):1049-58. doi: 10.1016/j.amjmed.2010.06.021.

DOI:10.1016/j.amjmed.2010.06.021

PMID:21035593

Abstract

BACKGROUND

Elevations in cardiac troponin have prognostic importance in critically ill patients. However, there are no data addressing the independent association between troponin levels and mortality, adjusted for the severity of the underlying disease, in patients hospitalized for acute respiratory disorders. We investigated whether troponin T (cTnT) elevations are independently associated with in-hospital mortality in patients in the intensive care unit (ICU) admitted for severe and acute respiratory conditions. After adjusting for the severity of disease measured by the Acute Physiology, Age, and Chronic Health Evaluation (APACHE) III prognostic system, we evaluated short-term (30 days) and long-term (3 years) mortality.

METHODS

We studied the APACHE III database and cTnT levels from patients admitted consecutively to the ICU at Mayo Clinic, Rochester, Minnesota. Between January 2001 and December 2005, 2078 patients with respiratory conditions had cTnT measured at ICU admission. In-hospital, short-term (30 days) and long-term (3 years) all-cause mortality were determined.

RESULTS

Of the study patients, 878 (42.3%) had elevated cTnT and 1200 patients (57.7%) had undetectable cTnT. During hospitalization, 1.1% of the patients with troponin T <0.01 ng/mL died compared to 21% of those with troponin T ≥0.01 ng/mL (P <.0001). At 30 days, mortality was 18.6% in patients with elevations of cTnT and 1.5% in patients without elevations of cTnT (P <.0001). The Kaplan-Meier probability of survival at 1-year follow-up was 71.0%, at 2-year follow-up was 48.3%, and 3-year follow-up was 39.4% with troponin T ≥0.01 ng/mL and at 1-year follow-up was 98.8%, at 2-year follow-up was 97.2%, and at 3-year follow-up was 95.5% with troponin T <0.01 μg/L (P <.0001). After adjustment for severity of disease and baseline characteristics, cTnT levels remained associated with in-hospital, short-term and long-term mortality (P <.0001).

CONCLUSIONS

In patients admitted to the ICU for respiratory disorders, cTnT elevations are independently associated with in-hospital, short-term and long-term mortality.

摘要

背景

心脏肌钙蛋白升高对危重症患者具有预后意义。然而，目前尚无数据表明，在因急性呼吸疾病住院的患者中，校正潜在疾病严重程度后，肌钙蛋白水平与死亡率之间存在独立关联。我们研究了在因严重和急性呼吸疾病而入住重症监护病房（ICU）的患者中，肌钙蛋白 T（cTnT）升高是否与院内死亡率独立相关。在调整急性生理学、年龄和慢性健康评估（APACHE）III 预后系统测量的疾病严重程度后，我们评估了短期（30 天）和长期（3 年）死亡率。

方法

我们研究了明尼苏达州罗切斯特市梅奥诊所 ICU 连续收治的患者的 APACHE III 数据库和 cTnT 水平。在 2001 年 1 月至 2005 年 12 月期间，有 2078 例呼吸状况患者在 ICU 入院时检测了 cTnT。确定了院内、短期（30 天）和长期（3 年）全因死亡率。

结果

在研究患者中，878 例（42.3%）cTnT 升高，1200 例（57.7%）cTnT 未升高。住院期间，cTnT<0.01ng/ml 的患者死亡率为 1.1%，而 cTnT≥0.01ng/ml 的患者死亡率为 21%（P<.0001）。30 天时，cTnT 升高的患者死亡率为 18.6%，cTnT 不升高的患者死亡率为 1.5%（P<.0001）。Kaplan-Meier 生存概率在 1 年随访时为 71.0%，在 2 年随访时为 48.3%，在 3 年随访时为 39.4%，cTnT≥0.01ng/ml，在 1 年随访时为 98.8%，在 2 年随访时为 97.2%，在 3 年随访时为 95.5%，cTnT<0.01μg/L（P<.0001）。在调整疾病严重程度和基线特征后，cTnT 水平仍与院内、短期和长期死亡率相关（P<.0001）。