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Elevated Troponin I and its prognostic significance in acute liver failure.
Crit Care. 2012 Nov 28;16(6):R228
Authors: Audimoolam VK, McPhail MJ, Sherwood R, Willars C, Bernal W, Wendon JA, Auzinger G
Abstract
ABSTRACT: INTRODUCTION: Acute liver failure (ALF) is a life-threatening multi-system illness complicated by multiple organ failure (MOF) and haemodynamic disturbances. Morbidity and mortality remains high and various prognostic and scoring models are in use to predict outcome. A recent observation in a large cohort of ALF patients suggested a prognostic value of troponin I (cTnI) and its role as a marker of sub-clinical myocardial injury and outcome. METHODS: Data from consecutive ALF patients over a 4-year period from January 2007 -March 2011 were included. The aim of this study was to correlate any relationship that may exist between cTnI, mortality, severity of illness and non hepatic organ failure. RESULTS: 218 subjects (age 36 (16-90) yrs, M: F 103:115) were studied.136 had an elevated cTnI > 0.05mug/L. Higher organ failure scores were found with positive cTnI: APACHE II (19.5 (3-51) v 14 (2-51), p=0.001), APACHE 111 (81(15-148) v 59(8-172) p=<0.001) SOFA (15 (4-20) v 13 (2-21), p=0.027) and SAPS (48 (12-96) v 34(12-97), p=0.001). Patients with positive cTnI had higher serum creatinine (192 umol/l (38-550) v 117 umol/l (46-929), p<0.001), arterial lactate (0.25,p<0.001) and a lower pH (-0.21, p=0.002). Also a higher proportion required renal replacement therapy (78% v 60%, p=0.006). Patients with elevated cTnI more frequently required vasopressors- norepinephrine (73% v 50%, p=0.008). Elevated cTnI did not predict outcome as effectively as other models (AUROC 0.61 (95% CI 0.52 - 0.68). CONCLUSIONS: More than 60% of ALF patients in this study demonstrated elevated cTnI. Despite a close correlation with organ failure severity, cTnI was a poor independent predictor of outcome. cTnI may not represent true myocardial injury and may be better viewed as a marker of metabolic stress.
PMID: 23190744 [PubMed - as supplied by publisher]