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Observational Study
. 2018 Dec:48:26-31.
doi: 10.1016/j.jcrc.2018.08.009. Epub 2018 Aug 16.

Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome

Thomas S Metkus  1 , Eliseo Guallar  2 , Lori Sokoll  3 , David A Morrow  4 , Gordon Tomaselli  5 , Roy Brower  6 , Bo Soo Kim  6 , Steven Schulman  5 , Frederick K Korley  7
Affiliations
Observational Study

Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome

Thomas S Metkus et al. J Crit Care. 2018 Dec.

Abstract

Purpose: Myocardial injury connotes worse prognosis in the Acute Respiratory Distress Syndrome (ARDS), however the prognostic connotation of changes in cardiac troponin (cTn) levels in ARDS patients is not known.

Methods: We performed a study of 908 ARDS patients enrolled in two previously completed ARDS Network trials. We obtained plasma samples via the NIH BIOLINCC repository and measured cTn using the ARCHITECT STAT high sensitivity troponin-I assay (Abbott Laboratories) at trial day 0 and 3. We constructed Cox proportional hazard models to determine the association between 60-day mortality and quintiles of percentage change in high-sensitivity troponin (ΔhsTnI).

Results: The median percent change in hsTnI (%ΔhsTnI) from day 0 to day 3 was -58.2% (IQR -79.0 to 0%). After multivariable adjustment, participants with a 32.1% or greater increase in hsTnI between day 0 and day 3 (highest quintile) had a 2.27 fold increased risk for mortality (95% CI 1.29 - 3.99, p = 0.002) as well as fewer ventilator-free and ICU-free days compared to the lowest quintile.

Conclusion: Progressive myocardial injury in ARDS patients is associated with worse outcome, independent of severity of critical illness. Investigation of the mechanisms underlying this relationship is warranted to guide possible strategies to mitigate myocardial injury in ARDS.

Keywords: ARDS; Cardiac; Hypoxia; Myocardial injury; Troponin.

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Figures

Fig 1.
Fig 1.
Histogram of the distributions of day 0 and day 3 high-sensitivity troponin levels. The white bar represents those subjects with undetectable high-sensitivity troponin levels. The dotted line represents a high-sensitivity troponin level of 26 ng/L, corresponding to the 99th percentile reference value of a healthy population.
Fig 2.
Fig 2.
Kaplan-Meier curves for cumulative mortality by quintiles of percent change in high-sensitivity troponin levels between day 0 and day 3.
See this image and copyright information in PMC

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