Myocardial Injury in Critically Ill Patients with Community-acquired Pneumonia: A Cohort Study.
Ann Am Thorac Soc. 2018 Dec 06;:
Authors: Frencken JF, van Baal L, Kappen TH, Donker DW, Horn J, van der Poll T, van Klei WA, Bonten MJM, Cremer OL, MARS consortium
RATIONALE: Myocardial injury, as reflected by elevated cardiac troponin levels in plasma, is common in patients with community-acquired pneumonia (CAP), but its temporal dynamics and etiology remain unknown.
OBJECTIVES: Our aim was to determine the incidence of troponin release in patients with CAP and identify risk factors which may point to underlying etiologic mechanisms.
METHODS: We included consecutive patients admitted with severe CAP to two intensive care units in the Netherlands between 2011 and 2015. High-sensitivity cardiac troponin I was measured daily during the first week. We used multivariable linear regression to identify variables associated with troponin release on admission, and mixed-effects regression to model the daily rise and fall of troponin levels over time.
RESULTS: Among 200 eligible patients, 179 were included, yielding 792 observation days. A total of 152 (85%) patients developed raised troponin levels >26 ng/L. Baseline factors independently associated with troponin release included coronary artery disease (176% increase, 95% CI 11-589), smoking (248% increase, 95% CI 33-809), and higher APACHE IV score (2% increase, 95% CI 0.8-3.3), whereas Staphylococcus aureus as a causative pathogen was protective (70% reduction, 95% CI 18-89). Time-dependent risk factors independently associated with daily increase in troponin concentrations included reduced platelet count (2.3% increase, 95% CI 0.6-4), tachycardia (1.5% increase, 95% CI 0.1-2.9), hypotension (6.2% increase, 95% CI 2.1-10.6) dobutamine use (44% increase 95% CI 12-85), prothrombin time (8.2% increase, 95% CI 0.2-16.9), white-cell count (1.7% increase, 95% CI 0-3.5), and fever (22.7% increase, 95% CI 0.1-49.6).
CONCLUSIONS: Cardiac injury develops in a majority of patients with severe CAP. Myocardial oxygen supply-demand mismatch and activated inflammation/coagulation are potential causes of this injury. Clinical trial registered with ClinicalTrials.gov (NCT01905033).
PMID: 30521759 [PubMed - as supplied by publisher]