TY - JOUR
T1 - Prevalence and prognostic association of circulating troponin in the acute respiratory distress syndrome
AU - Metkus, Thomas S.
AU - Guallar, Eliseo
AU - Sokoll, Lori
AU - Morrow, David
AU - Tomaselli, Gordon
AU - Brower, Roy
AU - Schulman, Steven
AU - Korley, Frederick K.
N1 - Funding Information:
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal). Dr. Metkus’s institution received funding from Abbott Laboratories and the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (salary support from grant number T32-HL007227-40, 2014–2016); he received funding from BestDoctors (consulting [unrelated to subject matter]), Oakstone/EBIX (consulting [unrelated to subject matter]), and McGraw-Hill Publishing (royalties, unrelated to this subject matter); he disclosed that Abbott Laboratories provided reagents and financial support for the study, but the study was designed and executed solely by the study investigators without industry involvement; he received support for article research from the NIH, and he disclosed off-label product use of high sensitivity troponin assays, which are not yet approved or have just recently been approved for clinical use in the United States (these assays are in routine clinical use in Europe). Dr. Sokoll’s institution received funding from Abbott Laboratories and disclosed reagent support from Abbott Laboratories. Dr. Morrow received funding from consulting for Abbott Laboratories, Roche Diagnostics, diaDexus; he reports grants to the Thrombolysis in Myocardial Infarction Study Group (for studies other than the one in this article) from Abbott Laboratories, Amgen, AstraZeneca, Daiichi Sankyo, Eisai, GlaxoSmithKline, Merck, Novartis, Roche Diagnostics, and Singulex, and he received consultant fees from Abbott Laboratories, AstraZeneca, diaDexus, GlaxoSmithKline, Merck, Peloton, Roche Diagnostics, and Verseon. Dr. Tomaselli received support for article research from the NIH. Dr. Brower received funding from Applied Clinical Intelligence and Global Therapeutics. Dr. Korley’s institution received funding from Abbott Laboratories, and he disclosed funding from prior consulting for Abbott Laboratories and Roche Diagnostics. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: tmetkus1@jhmi.edu Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Objective: Circulating cardiac troponin has been associated with adverse prognosis in the acute respiratory distress syndrome in small and single-center studies; however, comprehensive studies of myocardial injury in acute respiratory distress syndrome using modern high-sensitivity troponin assays, which can detect troponin at much lower circulating concentrations, have not been performed. Design: We performed a prospective cohort study. Setting: We included patients enrolled in previously completed trials of acute respiratory distress syndrome. Patients: One thousand fifty-seven acute respiratory distress syndrome patients were included. Interventions: To determine the association of circulating high-sensitivity troponin I (Abbott ARCHITECT), with acute respiratory distress syndrome outcomes, we measured high-sensitivity troponin I within 24 hours of intubation. The primary outcome was 60-day mortality. Measurements and Main Results: Detectable high-sensitivity troponin I was present in 94% of patients; 38% of patients had detectable levels below the 99th percentile of a healthy reference population (26 ng/L), whereas 56% of patients had levels above the 99th percentile cut point. After multivariable adjustment, age, cause of acute respiratory distress syndrome, temperature, heart rate, vasopressor use, Sequential Organ Failure Assessment score, creatinine, and Pco2 were associated with higher high-sensitivity troponin I concentration. After adjustment for age, sex, and randomized trial assignment, the hazard ratio for 60-day mortality comparing the fifth to the first quintiles of high-sensitivity troponin I was 1.61 (95% CI, 1.11-2.32; p trend = 0.003). Adjusting for Sequential Organ Failure Assessment score suggested that this association was not independent of disease severity (hazard ratio, 0.95; 95% CI, 0.64-1.39; p = 0.93). Conclusions: Circulating troponin is detectable in over 90% of patients with acute respiratory distress syndrome and is associated with degree of critical illness. The magnitude of myocardial injury correlated with mortality.
AB - Objective: Circulating cardiac troponin has been associated with adverse prognosis in the acute respiratory distress syndrome in small and single-center studies; however, comprehensive studies of myocardial injury in acute respiratory distress syndrome using modern high-sensitivity troponin assays, which can detect troponin at much lower circulating concentrations, have not been performed. Design: We performed a prospective cohort study. Setting: We included patients enrolled in previously completed trials of acute respiratory distress syndrome. Patients: One thousand fifty-seven acute respiratory distress syndrome patients were included. Interventions: To determine the association of circulating high-sensitivity troponin I (Abbott ARCHITECT), with acute respiratory distress syndrome outcomes, we measured high-sensitivity troponin I within 24 hours of intubation. The primary outcome was 60-day mortality. Measurements and Main Results: Detectable high-sensitivity troponin I was present in 94% of patients; 38% of patients had detectable levels below the 99th percentile of a healthy reference population (26 ng/L), whereas 56% of patients had levels above the 99th percentile cut point. After multivariable adjustment, age, cause of acute respiratory distress syndrome, temperature, heart rate, vasopressor use, Sequential Organ Failure Assessment score, creatinine, and Pco2 were associated with higher high-sensitivity troponin I concentration. After adjustment for age, sex, and randomized trial assignment, the hazard ratio for 60-day mortality comparing the fifth to the first quintiles of high-sensitivity troponin I was 1.61 (95% CI, 1.11-2.32; p trend = 0.003). Adjusting for Sequential Organ Failure Assessment score suggested that this association was not independent of disease severity (hazard ratio, 0.95; 95% CI, 0.64-1.39; p = 0.93). Conclusions: Circulating troponin is detectable in over 90% of patients with acute respiratory distress syndrome and is associated with degree of critical illness. The magnitude of myocardial injury correlated with mortality.
KW - cardiac
KW - myocardial injury
KW - respiratory failure
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U2 - 10.1097/CCM.0000000000002641
DO - 10.1097/CCM.0000000000002641
M3 - Article
C2 - 28777195
AN - SCOPUS:85030441833
SN - 0090-3493
VL - 45
SP - 1709
EP - 1717
JO - Critical care medicine
JF - Critical care medicine
IS - 10
ER -