Samuel Nathan A, Roddick Alistair, Glampson Ben, Mulla Abdulrahim, Davies Jim, Papadimitriou Dimitri, Panoulas Vasileios, Mayer Erik, Woods Kerrie, Shah Anoop D, Gautama Sanjay, Elliott Paul, Hemmingway Harry, Williams Bryan, Asselbergs Folkert W, Melikian Narbeh, Kharbanda Rajesh, Shah Ajay M, Perera Divaka, Patel Riyaz S, Channon Keith M, Mayet Jamil, Shah Anoop S V, Kaura Amit
NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, U.K.
NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, U.K.
Cardiooncology. 2024 Jul 5;10(1):41. doi: 10.1186/s40959-024-00238-w.
Cardiac troponin is commonly raised in patients presenting with malignancy. The prognostic significance of raised troponin in these patients is unclear.
We sought to investigate the relation between troponin and mortality in a large, well characterised cohort of patients with a routinely measured troponin and a primary diagnosis of malignancy.
We used the National Institute for Health Research (NIHR) Health Informatics Collaborative data of 5571 patients, who had troponin levels measured at 5 UK cardiac centres between 2010 and 2017 and had a primary diagnosis of malignancy. Patients were classified into solid tumour or haematological malignancy subgroups. Peak troponin levels were standardised as a multiple of each laboratory's 99th -percentile upper limit of normal (xULN).
4649 patients were diagnosed with solid tumours and 922 patients with haematological malignancies. Raised troponin was an independent predictor of mortality in all patients (Troponin > 10 vs. <1 adjusted HR 2.01, 95% CI 1.73 to 2.34), in solid tumours (HR 1.84, 95% CI 1.55 to 2.19), and in haematological malignancy (HR 2.72, 95% CI 1.99 to 3.72). There was a significant trend in increasing mortality risk across troponin categories in all three subgroups (p < 0.001).
Raised troponin level is associated with increased mortality in patients with a primary diagnosis of malignancy regardless of cancer subtype. Mortality risk is stable for patients with a troponin level below the ULN but increases as troponin level increases above the ULN in the absence of acute coronary syndrome.
恶性肿瘤患者中肌钙蛋白通常会升高。这些患者中肌钙蛋白升高的预后意义尚不清楚。
我们试图在一个大型、特征明确的队列中研究肌钙蛋白与死亡率之间的关系，该队列中的患者常规检测肌钙蛋白且初步诊断为恶性肿瘤。
我们使用了英国国家卫生研究院（NIHR）健康信息协作组织的数据，涉及5571例患者，这些患者于2010年至2017年在英国5个心脏中心检测了肌钙蛋白水平，且初步诊断为恶性肿瘤。患者被分为实体瘤或血液系统恶性肿瘤亚组。肌钙蛋白峰值水平标准化为每个实验室正常上限第99百分位数（xULN）的倍数。
4649例患者被诊断为实体瘤，922例患者为血液系统恶性肿瘤。肌钙蛋白升高是所有患者（肌钙蛋白>10 vs.<1，调整后HR 2.01，95%CI 1.73至2.34）、实体瘤患者（HR 1.84，95%CI 1.55至2.19）和血液系统恶性肿瘤患者（HR 2.72，95%CI 1.99至3.72）死亡率的独立预测因素。在所有三个亚组中，肌钙蛋白类别之间的死亡风险均有显著的上升趋势（p<0.001）。
初步诊断为恶性肿瘤的患者，无论癌症亚型如何，肌钙蛋白水平升高均与死亡率增加相关。在无急性冠状动脉综合征的情况下，肌钙蛋白水平低于ULN的患者死亡风险稳定，但随着肌钙蛋白水平高于ULN而增加。
