Clinical Determinants of Myocardial Injury, Detectable and Serial Troponin Levels among Patients with Hypertensive Crisis
Clinical Determinants of Myocardial Injury, Detectable and Serial Troponin Levels among Patients with Hypertensive Crisis
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DOI：
10.7759/cureus.6787
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发表时间：
2020-01-27
影响因子：
1.2
通讯作者：
Irfan, Affan
中科院分区：
文献类型：
--
作者：
Acosta, Giancarlo;Amro, Ahmed;Irfan, Affan
心肌肌钙蛋白水平升高是高血压危象伴心肌损伤的高发病率。诱发患者发生心肌损伤的危险因素，可检测的肌钙蛋白，以及该人群中连续肌钙蛋白的增加尚不清楚。MethodsA回顾性研究设计包括所有进入急诊室、诊断为高血压危象的患者，使用国际疾病分类，第10次修订，2016-2018年的临床修改（ICD-10-CM）代码（n=467）。Logistic回归分析用于确定心肌损伤的重要预测因素，证明肌钙蛋白升高>第99百分位数的上限参考水平（URL），可检测的肌钙蛋白（> 0.015 ng/ml），并增加系列肌钙蛋白level.ResultsThe第99百分位数的初始肌钙蛋白水平在所有患者中为0.433 ng/ml。共有15%的患者发生心肌损伤，与此相关的显著危险因素为体重指数（BMI）< 30 kg/m2（比值比[OR] 0.50，置信区间[CI] 0.28-0.89）、充血性心力衰竭（CHF; OR 4.28，CI 2.21-8.25）和既往使用阿司匹林（OR 1.98，CI 1.08-3.63）。约35%的患者可检测到肌钙蛋白，BMI < 30 kg/m2（OR 0.62，CI 0.40-0.97），CHF（OR 3.49，CI 2.06-5.9），肌酐升高（OR 1.17，CI 1.02-1.34）和年龄第99百分位数URL，这些患者中的大多数在连续肌钙蛋白方面变化极小。低BMI与较高的初始和连续肌钙蛋白水平相关，这种肥胖悖论在女性和老年患者中更强。
IntroductionThere is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known.MethodsA retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). Logistic regression was used to determine the important predictors of myocardial injury evidenced by troponin elevation >99th percentile of upper reference level (URL), detectable troponin (> 0.015 ng/ml), and increase in serial troponin levels.ResultsThe 99th percentile of the initial troponin level among all patients was 0.433 ng/ml. A total of 15% had a myocardial injury, and the significant risk factors associated with it were body mass index (BMI) < 30 kg/m(2) (odds ratio [OR] 0.50, confidence interval [CI] 0.28-0.89), congestive heart failure (CHF; OR 4.28, CI 2.21-8.25) and prior use of aspirin (OR 1.98, CI 1.08-3.63). About 35% had detectable troponin, and BMI < 30 kg/m(2) (OR 0.62, CI 0.40-0.97), CHF (OR 3.49, CI 2.06-5.9), elevated creatinine (OR 1.17, CI 1.02-1.34) and age 99th percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients.