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. 2025 Nov 21;17(11):e97444.
doi: 10.7759/cureus.97444. eCollection 2025 Nov.

Examining the Severity and Consequences of Patients Admitted With Acute Chest Pain via the Acute Physiology and Chronic Health Evaluation II Score and the Relevance of Adding High-Sensitivity Troponin Testing

Yasmeen Farag  1 , Nada M Breika  2 , Abdulmabod Omar  3   4 , Mohamed E Owis  5 , Mohamed Abdelrazek  6 , Mina Soliman  7 , Abdelrahman Embabi  8 , Riham Nour  9 , Muhamad Essam Muhamad Eldeeb  10 , Mahmoud Farahat Ebrahim  11 , Ahmad Adel Abdelhameed Muhammad  12 , Ahmed G Ataalla  13 , Amira Elzohary  14 , Mohamed Tarek Saad Ramadan  15 , Andrew Essam Habib Tawdros  16 , Ahmed Maher Mohamed Elsayed  17 , Nourhan Amr Mohamed Abouelsoud Salem  18
Affiliations

Examining the Severity and Consequences of Patients Admitted With Acute Chest Pain via the Acute Physiology and Chronic Health Evaluation II Score and the Relevance of Adding High-Sensitivity Troponin Testing

Yasmeen Farag et al. Cureus. .

Abstract

Background Acute chest pain is a critical presentation in intensive care units (ICUs), demanding rapid and accurate risk stratification to guide timely intervention. While the Acute Physiology and Chronic Health Evaluation II (APACHE II) score quantifies physiological severity, high-sensitivity (HS) troponin offers a biochemical measure of myocardial stress. However, their combined prognostic potential in ICU chest pain populations remains underexplored. Objective This study aimed to evaluate the severity and outcomes of ICU patients admitted with acute chest pain using the APACHE II score and to determine the added prognostic relevance of HS troponin testing for mortality prediction. Methods A cross-sectional analytical study of 100 ICU patients was conducted at Hassan Ghazzawi Hospital (January-August 2025). Data on demographics, physiological variables, APACHE II scores, and HS troponin status were analysed using SPSS version 26.0 (IBM Corp., Armonk, NY). Results Non-survivors exhibited significantly higher APACHE II scores (19.0 ± 6.2 vs 11.1 ± 6.1, p < 0.001). HS troponin positivity was strongly associated with mortality (87% vs 20%, p < 0.001; OR = 27.8). Both APACHE II (OR = 1.18) and HS troponin (OR = 21.7) were independent mortality predictors. The model demonstrated excellent discrimination (AUC = 0.89) and good calibration (p = 0.65). Conclusion Both APACHE II score and HS troponin levels were evaluated as independent predictors of mortality using multivariate logistic regression analysis. Combined physiological and biochemical assessment enables superior risk stratification, optimising early intervention and improving clinical decision-making.

Keywords: acute chest pain; apache ii; critical care; high-sensitivity troponin; icu mortality; logistic regression; myocardial injury; prognostic accuracy; risk stratification; roc curve.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board (IRB)/Ethics Committee of Hassan Ghazzawi Hospital issued approval DHGH-MBEC-2508. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

References

    1. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Gulati M, Levy PD, Mukherjee D, et al. https://doi.org/10.1161/cir.0000000000001029. Circulation. 2021;144:0–454. - PubMed
    1. APACHE II: a severity of disease classification system. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. https://pubmed.ncbi.nlm.nih.gov/3928249/ Crit Care Med. 1985;13:818–829. - PubMed
    1. High-sensitivity troponin: a review on characteristics, assessment, and clinical implications. Lazar DR, Lazar FL, Homorodean C, Cainap C, Focsan M, Cainap S, Olinic DM. Dis Markers. 2022;2022:9713326. - PMC - PubMed
    1. Effectiveness and safety of the ESC-TROP (European Society of Cardiology 0h/1h troponin rule-out protocol) trial. Mokhtari A, Forberg JL, Sandgren J, et al. J Am Heart Assoc. 2024;13:0. - PMC - PubMed
    1. The diagnostic accuracy of the ESC 0/1-hour algorithm in non-ST-segment elevation myocardial infarction in a crowded emergency department: a real-world experience from a single-center in Türkiye. Kudu E, Kucukardali AE, Altun M, et al. BMC Emerg Med. 2025;25:129. - PMC - PubMed

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