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Elevated cardiac troponin T in cirrhotic patients with emergency care admissions: Associations with mortality
Author(s) -
Elnegouly Mayada,
Umgelter Katrin,
Safi Wajima,
Hapfelmeier Alexander,
Schmid Roland M,
Umgelter Andreas
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13902
Subject(s) - medicine , hazard ratio , troponin complex , confidence interval , cirrhosis , emergency department , liver disease , chronic liver disease , troponin t , gastroenterology , troponin , cardiology , myocardial infarction , psychiatry
Background and Aim Mortality of cirrhotic patients after emergency care admission is high, and prognostic factors can help in prioritizing patients. The aim of our study was to assess the association between levels of cardiac troponin T (cTnT) and 1‐year mortality in patients with liver cirrhosis without known cardiac disease, who were admitted to the emergency department (ED).Methods All patients with cirrhosis presented to the ED from October 2009 until August 2015 who had an initial cTnT value measured with the first lab panel were retrospectively analyzed with a follow‐up of 365 days.Results Of a total of 237 cirrhotic ED patients, cTnT measurements were available for 87 (63% men, mean age 58.9 ± 11.0 years, and median Model for End‐stage Liver Disease score was 15 [25th–75th percentile: 10–19]). Chronic Liver Failure Consortium acute‐on‐chronic liver failure (CLIF‐C‐ACLF) score was 33.[1][Ripoll C, 2005], [2][Llach J, 1988], [3][Pozzi M, 1997], [4][Moller S, 2006], [5][Lossnitzer D, 2010], [6][Parekh NK, 2007], [7][Wong P, 2007], [8][Bardaji A, 2015], [9][Roongsritong C, 2004], [10][Wu AH, 2001], [11][Bernardi M, 2015], [12][Claria J, 2016], [13][Charlton MR, 2009], [14][Nair S, 2002], [15][Botta F, 2003], [16][Zhou XD, 2016], [17][Keller T, 2009], [18][Botto F, 2014] Forty‐three patients (49%) had cTnT values above the normal range (14 ng/L), of which 19 (22%) had values over 30 ng/L. Two patients were lost to follow‐up. In multivariable analysis, both CLIF‐C‐ACLF (hazard ratio 1.072 per point increase; 95% confidence interval 1.029–1.117; P < 0.001) and cTnT (hazard ratio 1.014 per ng/L increase; 95% confidence interval 1.004–1.024; P = 0.008) emerged as independently associated with mortality.Conclusions A large proportion of cirrhotic patients in the ED have elevated levels of cTnT even if there is no evidence of cardiac disease. Elevated cTnT is associated with increased mortality during 1 year after correcting for Model for End‐stage Liver Disease and CLIF‐C‐ACLF scores.