Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Can J Anaesth. 2019 Jun;66(6):648-657. doi: 10.1007/s12630-019-01375-y. Epub 2019 Apr 29.
Elevated cardiac troponin concentrations in people with critical illness are associated with an increased risk of death. We aimed to assess the feasibility of a larger study to ascertain the utility of cardiac troponin as a prognostic tool for mortality in critically ill patients.
Patients admitted to participating intensive care units during the one-month enrolment period were eligible. We excluded cardiac surgical patients and patients who were admitted and either died or were discharged within 12 hr. In enrolled patients, we measured high-sensitivity cardiac troponin I (hs-cTnI) and obtained electrocardiograms to ascertain the incidence of myocardial infarction (MI) and isolated troponin elevation. Our feasibility objectives were to measure recruitment rate, the proportion of patients who consented under a deferred consent model, and time required for data collection and study procedures.
Over a four-week enrolment period, 280 patients were enrolled using a deferred consent model. We obtained subsequent consent from 81% of patients. Study procedures and data collection required 1.7 hr per participant. Overall, 86 (38%) suffered a MI, 23 (10%) had an isolated hs-cTnI elevation, and 117 (52%) had no hs-cTnI elevation. The crude hospital mortality rate was 10% without an hs-cTnI elevation, 29% with an isolated hs-cTnl elevation (relative risk [RR]) 2.2; 95% confidence interval [CI], 1.0 to 6.0) and 29% with an MI (RR, 2.6; 95% CI, 1.4 to 5.1).
Myocardial injury with elevated hs-cTnI concentrations and MIs occur frequently during critical illness. This pilot study has established the feasibility of conducting a large-scale investigation addressing this issue.
危重病患者中心肌肌钙蛋白浓度升高与死亡风险增加相关。我们旨在评估一项更大规模研究的可行性，以确定心肌肌钙蛋白作为危重病患者死亡率预后工具的效用。
符合条件的患者为在参与的重症监护病房一个月的入组期间内入院的患者。我们排除了心脏手术患者和入院后 12 小时内死亡或出院的患者。在入组患者中，我们测量高敏心肌肌钙蛋白 I（hs-cTnI）并进行心电图检查，以确定心肌梗死（MI）和孤立性肌钙蛋白升高的发生率。我们的可行性目标是测量招募率、根据延迟同意模型同意的患者比例以及数据收集和研究程序所需的时间。
在四周的入组期间，使用延迟同意模型入组了 280 例患者。我们随后获得了 81%患者的同意。每个患者的研究程序和数据收集需要 1.7 小时。总体而言，86 例（38%）发生 MI，23 例（10%）出现孤立性 hs-cTnI 升高，117 例（52%）无 hs-cTnI 升高。无 hs-cTnI 升高的住院死亡率为 10%，孤立性 hs-cTnl 升高的死亡率为 29%（相对风险 [RR]）2.2；95%置信区间 [CI]，1.0 至 6.0），MI 的死亡率为 29%（RR，2.6；95% CI，1.4 至 5.1）。
危重病期间经常发生 hs-cTnI 浓度升高和 MI 的心肌损伤。这项初步研究已经确定了开展解决这一问题的大规模调查的可行性。
