Lee Yeon Joo, Lee Hongyeul, Park Ji Soo, Kim Se Joong, Cho Young-Jae, Yoon Ho Il, Lee Jae Ho, Lee Choon-Taek, Park Jong Sun
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
J Crit Care. 2015 Apr;30(2):390-4. doi: 10.1016/j.jcrc.2014.12.001. Epub 2014 Dec 4.
Elevated cardiac troponin (cTn) has been associated with worse outcomes in critically ill patients, but few studies have focused on whether these markers are related to outcomes in patients with severe pneumonia. We investigated the levels of cTnI in critically ill patients hospitalized for severe pneumonia and whether elevated levels of cTnI correlated with the clinical outcome of this patient group.
We conducted a retrospective study of patients admitted to the medical intensive care unit (ICU) with severe pneumonia with levels of cTnI obtained within 24 hours of admittance. Patients with evidence of acute coronary syndrome were excluded. A cTnI level greater than 0.034 ng/mL was considered positive. P value < .05 was considered significant.
A total of 152 patients (community-acquired pneumonia [39.5%], health care-associated pneumonia [40.8%], and hospital-acquired pneumonia [19.7%]) were included in the study. Eighty-eight (58%) patients had detectable cTnI levels (median, 0.049 ng/mL). Patients with increased cTnI levels showed higher in-ICU mortality (38.6% vs 21.9%, P = .028). The association between elevated cTnI levels and mortality remained significant after adjustment using a multivariate model (adjusted hazard ratio = 1.398; 95% confidence interval, 1.005-1.945; P = .047).
Increased levels of cTnI are an independent predictor of ICU mortality in patients hospitalized with severe pneumonia without evidence of acute coronary syndrome.
心肌肌钙蛋白（cTn）升高与危重症患者预后较差相关，但很少有研究关注这些标志物是否与重症肺炎患者的预后有关。我们调查了因重症肺炎住院的危重症患者的心肌肌钙蛋白I（cTnI）水平，以及cTnI水平升高是否与该患者群体的临床结局相关。
我们对入住医疗重症监护病房（ICU）的重症肺炎患者进行了一项回顾性研究，这些患者在入院24小时内检测了cTnI水平。排除有急性冠状动脉综合征证据的患者。cTnI水平大于0.034 ng/mL被视为阳性。P值<0.05被认为具有统计学意义。
共有152例患者（社区获得性肺炎[39.5%]、医疗保健相关肺炎[40.8%]和医院获得性肺炎[19.7%]）纳入研究。88例（58%）患者cTnI水平可检测到（中位数为0.049 ng/mL）。cTnI水平升高的患者ICU死亡率更高（38.6%对21.9%，P = 0.028）。使用多变量模型调整后，cTnI水平升高与死亡率之间的关联仍然显著（调整后的风险比 = 1.398；95%置信区间，1.005 - 1.945；P = 0.047）。
cTnI水平升高是无急性冠状动脉综合征证据的重症肺炎住院患者ICU死亡率的独立预测因素。
