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Elevated troponin T concentrations in critically ill patients

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Abstract

Objective

To determine the incidence of troponin T elevations among a selected group of critically ill patients, to correlate these findings to electrocardiographs, and to compare troponin T-positive and T-negative patients in relation to clinical parameters.

Design

Prospective study.

Setting

Mixed surgical and medical intensive care unit.

Patients

Thirty-four consecutive critically ill patients who were mechanically ventilated or underwent thoracic or vascular surgery.

Interventions

Blood samples were collected at admission, the next morning, and 24 h after the second blood sampling. These samples were used for troponin T measurement and electrocardiographs were made when troponin T levels were elevated.

Main results

Eleven of 34 patients (32%) had elevated troponin T levels, which were already present upon admission in eight out of 11 patients (73%). Most patients underwent surgery prior to ICU admission (21 of 34 patients). Significantly (P=0.0055) more troponin T-positive patients underwent acute surgery, and significantly more (P=0.045) troponin T-positive patients suffered from hypotension. Only four of the troponin T-positive patients were diagnosed as suffering from an acute myocardial infarction based on electrocardiographs. All troponin T-positive patients had coronary artery disease: nine had a history of CAD and two had actual CAD. No difference in mortality rates was observed between troponin T-positive and T-negative patients.

Conclusions

An unexpectedly high percentage of included patients had troponin T elevations, which could be corroborated by electrocardiographs in only four cases suggesting that a high percentage of critically ill patients with a history of CAD suffer from clinically unrecognised (minor) myocardial damage.

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Acknowledgements

We would like to thank Dr. E. Lamferts for critical evaluation of the electrocardiographs.

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Authors and Affiliations

  1. Department of Clinical Chemistry, Canisius-Wilhelmina Hospital, P.O. Box 9015, 6500 GS, Nijmegen, The Netherlands

    Jacqueline M. T. Klein Gunnewiek

  2. Department of Internal Medicine and Intensive Care Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands

    Joris J. J. P. M. van de Leur

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  1. Jacqueline M. T. Klein Gunnewiek
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  2. Joris J. J. P. M. van de Leur
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Correspondence to Jacqueline M. T. Klein Gunnewiek.

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Klein Gunnewiek, J.M.T., van de Leur, J.J.J.P.M. Elevated troponin T concentrations in critically ill patients. Intensive Care Med 29, 2317–2322 (2003). https://doi.org/10.1007/s00134-003-1953-2

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  • DOI: https://doi.org/10.1007/s00134-003-1953-2

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