• Emilie P Belley-Cote, Richard P Whitlock, Diana V Ulic, Kimia Honarmand, Abubaker Khalifa, Graham R McClure, Andrew Gibson, Fayez Alshamsi, Frederick D'Aragon, Bram Rochwerg, Erick Duan, Nevena Savija, Tim Karachi, François Lamontagne, Peter Kavsak, and Deborah J Cook.
• Department of Medicine, McMaster University, Hamilton, ON, Canada. emilie.belley-cote@phri.ca.
• Can J Anaesth. 2019 Jun 1; 66 (6): 648-657.

PurposeElevated cardiac troponin concentrations in people with critical illness are associated with an increased risk of death. We aimed to assess the feasibility of a larger study to ascertain the utility of cardiac troponin as a prognostic tool for mortality in critically ill patients.MethodsPatients admitted to participating intensive care units during the one-month enrolment period were eligible. We excluded cardiac surgical patients and patients who were admitted and either died or were discharged within 12 hr. In enrolled patients, we measured high-sensitivity cardiac troponin I (hs-cTnI) and obtained electrocardiograms to ascertain the incidence of myocardial infarction (MI) and isolated troponin elevation. Our feasibility objectives were to measure recruitment rate, the proportion of patients who consented under a deferred consent model, and time required for data collection and study procedures.ResultsOver a four-week enrolment period, 280 patients were enrolled using a deferred consent model. We obtained subsequent consent from 81% of patients. Study procedures and data collection required 1.7 hr per participant. Overall, 86 (38%) suffered a MI, 23 (10%) had an isolated hs-cTnI elevation, and 117 (52%) had no hs-cTnI elevation. The crude hospital mortality rate was 10% without an hs-cTnI elevation, 29% with an isolated hs-cTnl elevation (relative risk [RR]) 2.2; 95% confidence interval [CI], 1.0 to 6.0) and 29% with an MI (RR, 2.6; 95% CI, 1.4 to 5.1).ConclusionMyocardial injury with elevated hs-cTnI concentrations and MIs occur frequently during critical illness. This pilot study has established the feasibility of conducting a large-scale investigation addressing this issue.

23 keywords...

hide…