Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Respirology. 2017 Jul;22(5):1000-1006. doi: 10.1111/resp.12996. Epub 2017 Feb 21.
Mortality after hospitalization with community-acquired pneumonia (CAP) is high, compared with age-matched controls. Available evidence suggests a strong link with cardiovascular disease. Our aim was to explore the prognostic value of high-sensitivity cardiac troponin T (cTnT) for mortality in patients hospitalized with CAP.
CTnT level on admission was measured (assay conducted in 2015) in 295 patients hospitalized with CAP who participated in a randomized placebo-controlled double-blind trial on adjunctive dexamethasone treatment. Outcome measures were short- (30-day) and long-term (4.1-year) mortalities.
CTnT levels were elevated (≥14 ng/L) in 132 patients (45%). Pneumonia severity index (PSI) class was 4-5 in 137 patients (46%). Short- and long-term mortality were significantly higher in patients with elevated cTnT levels. cTnT level on admission combined with PSI classification was significantly better in predicting short-term mortality (area under the operating curve (AUC) = 0.903; 95% CI = 0.847-0.960), compared with PSI classification alone (AUC = 0.818; 95% CI = 0.717-0.919). An optimal cTnT cut-off level of 28 ng/L was independently associated with both short- and long-term mortality (OR = 21.9; 95% CI = 4.7-101.4 and 10.7; 95% CI = 5.0-22.8, respectively).
Elevated cTnT level on admission is a strong predictor of short- and long-term mortalities in patients hospitalized with CAP.
与年龄匹配的对照组相比，社区获得性肺炎（CAP）住院患者的死亡率较高。现有证据表明，这与心血管疾病有很强的关联。我们的目的是探讨高敏心肌肌钙蛋白 T（cTnT）对 CAP 住院患者死亡率的预后价值。
在一项关于辅助地塞米松治疗的随机安慰剂对照双盲试验中，共纳入了 295 名 CAP 住院患者，检测了入院时的 cTnT 水平（检测于 2015 年进行）。结局指标为短期（30 天）和长期（4.1 年）死亡率。
132 名患者（45%）的 cTnT 水平升高（≥14ng/L）。137 名患者（46%）的肺炎严重指数（PSI）分级为 4-5 级。cTnT 水平升高的患者短期和长期死亡率显著更高。入院时 cTnT 水平与 PSI 分类相结合，对短期死亡率的预测明显优于 PSI 分类（曲线下面积（AUC）=0.903；95%CI=0.847-0.960）。入院时 cTnT 的最佳截断值为 28ng/L，与短期和长期死亡率均独立相关（OR=21.9；95%CI=4.7-101.4 和 10.7；95%CI=5.0-22.8）。
入院时 cTnT 水平升高是 CAP 住院患者短期和长期死亡率的强有力预测指标。
