Thomas S Metkus1, Eliseo Guallar2, Lori Sokoll3, David A Morrow4, Gordon Tomaselli5, Roy Brower6, Bo Soo Kim6, Steven Schulman5, Frederick K Korley7. 1. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, United States. Electronic address: tmetkus1@jhmi.edu. 2. Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, United States. 3. Department of Pathology, Johns Hopkins University School of Medicine, United States. 4. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, United States. 5. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, United States. 6. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, United States. 7. Department of Emergency Medicine, University of Michigan Medical School, United States.
Abstract
PURPOSE: Myocardial injury connotes worse prognosis in the Acute Respiratory Distress Syndrome (ARDS), however the prognostic connotation of changes in cardiac troponin (cTn) levels in ARDS patients is not known. METHODS: We performed a study of 908 ARDS patients enrolled in two previously completed ARDS Network trials. We obtained plasma samples via the NIH BIOLINCC repository and measured cTn using the ARCHITECT STAT high sensitivity troponin-I assay (Abbott Laboratories) at trial day 0 and 3. We constructed Cox proportional hazard models to determine the association between 60-day mortality and quintiles of percentage change in high-sensitivity troponin (ΔhsTnI). RESULTS: The median percent change in hsTnI (%ΔhsTnI) from day 0 to day 3 was -58.2% (IQR -79.0 to 0%). After multivariable adjustment, participants with a 32.1% or greater increase in hsTnI between day 0 and day 3 (highest quintile) had a 2.27 fold increased risk for mortality (95% CI 1.29 - 3.99, p = 0.002) as well as fewer ventilator-free and ICU-free days compared to the lowest quintile. CONCLUSION: Progressive myocardial injury in ARDS patients is associated with worse outcome, independent of severity of critical illness. Investigation of the mechanisms underlying this relationship is warranted to guide possible strategies to mitigate myocardial injury in ARDS.
PURPOSE:Myocardial injury connotes worse prognosis in the Acute Respiratory Distress Syndrome (ARDS), however the prognostic connotation of changes in cardiac troponin (cTn) levels in ARDSpatients is not known. METHODS: We performed a study of 908 ARDSpatients enrolled in two previously completed ARDSNetwork trials. We obtained plasma samples via the NIH BIOLINCC repository and measured cTn using the ARCHITECT STAT high sensitivity troponin-I assay (Abbott Laboratories) at trial day 0 and 3. We constructed Cox proportional hazard models to determine the association between 60-day mortality and quintiles of percentage change in high-sensitivity troponin (ΔhsTnI). RESULTS: The median percent change in hsTnI (%ΔhsTnI) from day 0 to day 3 was -58.2% (IQR -79.0 to 0%). After multivariable adjustment, participants with a 32.1% or greater increase in hsTnI between day 0 and day 3 (highest quintile) had a 2.27 fold increased risk for mortality (95% CI 1.29 - 3.99, p = 0.002) as well as fewer ventilator-free and ICU-free days compared to the lowest quintile. CONCLUSION: Progressive myocardial injury in ARDSpatients is associated with worse outcome, independent of severity of critical illness. Investigation of the mechanisms underlying this relationship is warranted to guide possible strategies to mitigate myocardial injury in ARDS.
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