Prevalence and Prognostic Association of Circulating Troponin in the Acute Respiratory Distress Syndrome.
Prevalence and Prognostic Association of Circulating Troponin in the Acute Respiratory Distress Syndrome.
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DOI：
10.1097/ccm.0000000000002641
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发表时间：
2017-10
影响因子：
8.8
通讯作者：
Korley FK
中科院分区：
文献类型：
--
作者：
Metkus TS;Guallar E;Sokoll L;Morrow D;Tomaselli G;Brower R;Schulman S;Korley FK
在小型和单中心研究中，循环心肌肌钙蛋白与急性呼吸窘迫综合征(ARDS)的不良预后有关，然而，利用现代高灵敏度肌钙蛋白(HsTn)检测循环中肌钙蛋白浓度低得多的方法，对ARDS患者的心肌损伤进行全面的研究还未见报道。我们进行了一项前瞻性队列研究。我们纳入了参加先前完成的ARDS试验的患者。纳入1,057名ARDS患者。为了确定循环hsTnI(雅培建筑师)与ARDS结局的相关性，我们在插管后24小时内测量了hsTnI。主要结果是60天的死亡率。94%的患者存在可检测到的hsTnI；38%的患者的可检测水平低于健康参考人群(26 ng/L)的第99个百分位数，而56%的患者的水平高于第99%的分界点。多变量调整后，年龄、ARDS的病因、体温、心率、血管加压剂的使用、SOFA评分、肌酐和二氧化碳分压与较高的hsTnI浓度相关。在调整了年龄、性别和随机试验分配后，与hsTnI的第5和1个五分之一相比，60天死亡率的风险比为1.61(95%可信区间为1.11-2.32；P-趋势=0.003)。调整SOFA评分表明，这种关联并不独立于疾病严重程度(危险比0.95(95%可信区间0.64-1.39；P=0.93))。循环肌钙蛋白在90%以上的ARDS患者中可检测到，且与危重疾病的程度有关。心肌损伤程度与死亡率相关。
Circulating cardiac troponin has been associated with adverse prognosis in the acute respiratory distress syndrome (ARDS) in small and single center studies, however comprehensive studies of myocardial injury in ARDS using modern high-sensitivity troponin (hsTn) assays, which can detect troponin at much lower circulating concentrations, have not been performed. We performed a prospective cohort study. We included patients enrolled in previously completed trials of ARDS. 1,057 ARDS patients were included. To determine the association of circulating hsTnI (Abbott ARCHITECT), with ARDS outcomes, we measured hsTnI within 24 h of intubation. The primary outcome was 60-day mortality. Detectable hsTnI was present in 94% of patients; 38% of patients had detectable levels below the 99th percentile of a healthy reference population (26 ng/L), while 56% of patients had levels above the 99th percentile cut point. After multivariable adjustment, age, cause of ARDS, temperature, heart rate, vasopressor use, SOFA score, creatinine, and pCO2 were associated with higher hsTnI concentration. After adjustment for age, sex, and randomized trial assignment, the hazard ratio for 60-day mortality comparing the 5th to the 1st quintiles of hsTnI was 1.61 (95% CI 1.11 – 2.32; P-trend = 0.003). Adjusting for SOFA score suggested that this association was not independent of disease severity (hazard ratio 0.95 (95% CI 0.64 – 1.39; P = 0.93). Circulating troponin is detectable in over 90% of patients with ARDS and is associated with degree of critical illness. The magnitude of myocardial injury correlated with mortality.