Selected article for: "APACHE ii score and invasive ventilation"
Author: Demir, Ozan M.; Ryan, Matthew; Cirillo, Chiara; Desai, Nishita; Pericao, Ana; Sinclair, Hannah; Stylianidis, Vasileios; Victor, Kelly; Alaour, Bashir; Jones, Andrew; Pavlidis, Antonis N.; Retter, Andrew; Carr-White, Gerald; Camporota, Luigi; Barrett, Nicholas; Marber, Michael; Perera, Divaka
Title: Impact and Determinants of High-Sensitivity Cardiac Troponin-T Concentration in Patients With COVID-19 Admitted to Critical Care
  • Cord-id: oaag7asr
  • Document date: 2021_2_20
    • ID: oaag7asr
    Snippet: Cardiac Troponin (hs-TnT) elevation has been reported in unselected patients hospitalized with COVID-19 however the mechanism and relationship with mortality remain unclear. Consecutive patients admitted to a high-volume intensive care unit (ICU) in London with severe COVID-19 pneumonitis were included if hs-TnT concentration at admission was known. Kaplan-Meier survival analysis performed, with cohorts classified a priori by multiples of the upper limit of normal (ULN). 277 patients were admitt
    Document: Cardiac Troponin (hs-TnT) elevation has been reported in unselected patients hospitalized with COVID-19 however the mechanism and relationship with mortality remain unclear. Consecutive patients admitted to a high-volume intensive care unit (ICU) in London with severe COVID-19 pneumonitis were included if hs-TnT concentration at admission was known. Kaplan-Meier survival analysis performed, with cohorts classified a priori by multiples of the upper limit of normal (ULN). 277 patients were admitted during a 7-week period in 2020; 176 were included (90% received invasive ventilation). hs-TnT at admission was 16.5 (9.0 to 49.3) ng/L, 56% had concentrations >ULN. 56 patients (31.8%) died during the index admission. Admission hs-TnT level was lower in survivors (12.0 (8.0-27.8) vs 28.5 (14.0 to 81.0) ng/L, p = 0.001). Univariate predictors of mortality were age, APACHE-II Score and admission hs-TnT (HR 1.73, p = 0.007). By multivariate regression, only age (HR 1.33, CI: 1.16.to 1.51, p < 0.01) and admission hs-TnT (HR 1.94, CI: 1.22 to 3.10, p = 0.006) remained predictive. Survival was significantly lower when admission hs-TnT was >ULN (log-rank p-value<0.001). Peak hs-TnT was higher in those who died but was not predictive of death after adjustment for other factors. In conclusion, in critically ill patients with COVID-19 pneumonitis, the hs-TnT level at admission is a powerful independent predictor of the likelihood of surviving to discharge from ICU. In most cases, hs-TnT elevation does not represent major myocardial injury but acts as a sensitive integrated biomarker of global stress. Whether stratification based on admission Troponin level could be used to guide prognostication and management warrants further evaluation.

    Search related documents:
    Co phrase search for related documents
    • acute coronary syndrome and admission troponin: 1, 2, 3, 4, 5
    • acute coronary syndrome and admission troponin level: 1, 2
    • acute coronary syndrome and logistic regression: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
    • acute coronary syndrome and logistic regression analysis: 1, 2, 3, 4
    • acute physiologic assessment and admission available: 1
    • acute physiologic assessment and logistic regression: 1, 2
    • acute severity and admission available: 1, 2, 3
    • acute severity and admission day: 1, 2, 3, 4, 5, 6, 7
    • acute severity and logistic regression: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25
    • acute severity and logistic regression analysis: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
    • admission available and logistic regression: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20
    • admission available and logistic regression analysis: 1, 2, 3, 4
    • admission available and logistic regression analysis model: 1, 2
    • admission day and logistic regression: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25
    • admission day and logistic regression analysis: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24
    • admission day and logistic regression analysis model: 1
    • admission measure and logistic regression: 1, 2, 3, 4, 5, 6
    • admission measure and logistic regression analysis: 1, 2
    • admission troponin and logistic regression: 1, 2, 3, 4, 5, 6, 7, 8