Kollef M H, Ladenson J H, Eisenberg P R
Department of Internal Medeicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Chest. 1997 May;111(5):1340-7. doi: 10.1378/chest.111.5.1340.
To determine the relative importance of clinically recognized cardiac dysfunction and unrecognized cardiac injury to hospital mortality.
Prospective, blinded, single-center study.
Medical ICU of Barnes-Jewish Hospital, St. Louis, a university-affiliated teaching hospital.
Two hundred sixty adult patients requiring admission to the medical ICU.
Daily blood collection.
The presence of cardiac dysfunction (myocardial infarction, unstable angina, cardiac arrest, or congestive heart failure) as determined by the physicians responsible for the care of the patient. Daily measurement of levels of cardiac troponin I, a sensitive, highly specific, and long-lived marker of myocardial injury.
Fifty-five (21.2%) patients had clinical evidence of cardiac dysfunction, among whom 22 (40%) had an elevated level of cardiac troponin I. A total of 41 (15.8%) patients had evidence of acute myocardial injury based on elevated levels of cardiac troponin I. Patients with clinically recognized cardiac dysfunction had a significantly greater hospital mortality rate compared to patients without clinically recognized cardiac dysfunction (45.5% vs 10.2%; p < 0.001). Similarly, patients with elevated blood levels of cardiac troponin I had a greater hospital mortality rate compared to patients without elevated blood levels of cardiac troponin I (26.8% vs 16.0%; p = 0.095). Multiple logistic-regression analysis controlling for potential confounding variables demonstrated that the presence of clinically recognized cardiac dysfunction was independently associated with hospital mortality (adjusted odds ratio = 3.0; 95% confidence interval = 1.9 to 4.8; p = 0.016). However, having an elevated blood level of cardiac troponin I was not found to be an independent determinant of hospital mortality.
Among critically ill medical patients, clinically recognized cardiac dysfunction is an independent determinant of hospital mortality. The identification of unrecognized cardiac injury, using serial measurements of cardiac troponin I, did not independently contribute to the prediction of hospital mortality.
确定临床诊断的心脏功能障碍和未被识别的心脏损伤对医院死亡率的相对重要性。
前瞻性、盲法、单中心研究。
圣路易斯巴恩斯犹太医院的医学重症监护病房，一家大学附属医院。
260名需要入住医学重症监护病房的成年患者。
每日采血。
负责患者护理的医生确定的心脏功能障碍（心肌梗死、不稳定型心绞痛、心脏骤停或充血性心力衰竭）的存在情况。每日测量心肌肌钙蛋白I水平，这是一种敏感、高度特异且持续时间长的心肌损伤标志物。
55名（21.2%）患者有心脏功能障碍的临床证据，其中22名（40%）心肌肌钙蛋白I水平升高。基于心肌肌钙蛋白I水平升高，共有41名（15.8%）患者有急性心肌损伤的证据。有临床诊断心脏功能障碍的患者与无临床诊断心脏功能障碍的患者相比，医院死亡率显著更高（45.5%对10.2%；p<0.001）。同样，心肌肌钙蛋白I血水平升高的患者与心肌肌钙蛋白I血水平未升高的患者相比，医院死亡率更高（26.8%对16.9%；p=0.095）。控制潜在混杂变量的多因素逻辑回归分析表明，临床诊断的心脏功能障碍的存在与医院死亡率独立相关（调整后的优势比=3.0；95%置信区间=1.9至4.8；p=0.016）。然而，心肌肌钙蛋白I血水平升高未被发现是医院死亡率的独立决定因素。
在重症内科患者中，临床诊断的心脏功能障碍是医院死亡率的独立决定因素。通过连续测量心肌肌钙蛋白I来识别未被识别的心脏损伤，并未独立有助于预测医院死亡率。
