Unité de Réanimation Chirurgicale Polyvalente, Service d'Anesthésie Réanimation, Clichy, France.
Unité d'Epidémiologie Biostatistiques et Recherche Clinique, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, APHP, Clichy, France.
Br J Anaesth. 2018 Jun;120(6):1158-1164. doi: 10.1016/j.bja.2018.03.010. Epub 2018 Apr 17.
The significance of cardiac troponin I (cTnI) elevation after trauma is debated. We therefore explored the association between cTnI elevation at admission after trauma and ICU mortality.
We performed a retrospective analysis from a prospectively constituted database, of patients admitted to ICU after trauma at a single centre, over a 36 month period. According to cTnI plasma concentration at admission, patients were categorised into three groups: normal (<0.05 ng ml), intermediate (0.05-0.99 ng ml), or high concentration (≥1.0 ng ml). Associations of pre-hospital conditions or cTnI elevation and mortality were analysed by multivariate logistic regression.
Among the 994 patients, 177 (18%) had cTnI elevation at ICU admission. Of this total, 114 (11%) patients died in the ICU. The cTnI release was an independent predictor of ICU mortality with a concentration-response relationship [odds ratio (OR) 4.90 (2.19-11.16) and 14.83 (4.68-49.90) for intermediate and high concentrations, respectively] and Day 2 mortality [OR 2.23 (1.18-5.80) and 7.49 (2.77-20.12) for intermediate and high concentrations, respectively]. The severity of thoracic trauma [OR 2.25 (1.07-4.55) and 3.23 (2.00-5.27) for Abbreviated Injury Scale scores 1-2 and ≥3, respectively], out-of-hospital maximal heart rate ≥120 beats min [OR 2.22 (1.32-3.69)], and out-of-hospital shock [OR 2.02 (1.20-3.38)] were independently associated with cTnI elevation.
Release of cTnI was an independent predictor of ICU mortality, suggesting that this biomarker can be used in daily practice for early stratification of the risk of ICU death. Thoracic trauma was strongly associated with cTnI elevation.
心脏肌钙蛋白 I（cTnI）升高在创伤后的意义存在争议。因此，我们探讨了创伤后入院时 cTnI 升高与 ICU 死亡率之间的关系。
我们对一家中心 ICU 收治的创伤患者进行了一项前瞻性数据库的回顾性分析，研究时间为 36 个月。根据入院时的 cTnI 血浆浓度，患者分为三组：正常（<0.05ng/ml）、中值（0.05-0.99ng/ml）或高浓度（≥1.0ng/ml）。采用多变量逻辑回归分析了入院前状况或 cTnI 升高与死亡率的关系。
在 994 例患者中，177 例（18%）在 ICU 入院时 cTnI 升高。其中，114 例（11%）患者在 ICU 死亡。cTnI 释放是 ICU 死亡率的独立预测因子，具有浓度反应关系[比值比（OR）分别为 4.90（2.19-11.16）和 14.83（4.68-49.90）]和第 2 天死亡率[OR 分别为 2.23（1.18-5.80）和 7.49（2.77-20.12）]。胸外伤严重程度[OR 分别为 2.25（1.07-4.55）和 3.23（2.00-5.27），损伤严重程度评分分别为 1-2 和≥3]、院外最大心率≥120 次/min[OR 2.22（1.32-3.69）]和院外休克[OR 2.02（1.20-3.38）]与 cTnI 升高独立相关。
cTnI 的释放是 ICU 死亡率的独立预测因子，表明该生物标志物可用于日常实践，以早期分层 ICU 死亡风险。胸外伤与 cTnI 升高密切相关。
