• Thomas S Metkus, Eliseo Guallar, Lori Sokoll, David A Morrow, Gordon Tomaselli, Roy Brower, Bo Soo Kim, Steven Schulman, and Frederick K Korley.
• Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, United States. Electronic address: tmetkus1@jhmi.edu.
• J Crit Care. 2018 Dec 1; 48: 263126-31.

PurposeMyocardial 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.MethodsWe 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).ResultsThe 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.ConclusionProgressive 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.Copyright © 2018 Elsevier Inc. All rights reserved.

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