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High-sensitivity cardiac troponin T is an independent predictor of inhospital mortality in emergency department patients with suspected infection: a prospective observational derivation study
  1. Bas de Groot1,
  2. Ruben C W Verdoorn1,
  3. Joost Lameijer1,
  4. Jolanda van der Velden2
  1. 1SEH, Leiden University Medical Centre, Leiden, Zuid Holland, The Netherlands
  2. 2Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Dr Bas De Groot, CEH, Leiden University Medical Centre, Albinusdreef 2, Leiden, Zuid Holland 2300 RC, The Netherlands; b.de_groot.SEH{at}lumc.nl

Abstract

Introducion To assess the prognostic and discriminative accuracy of high-sensitivity cardiac troponin T (hs-cTnT) for prediction of inhospital mortality in emergency department (ED) patients with suspected infection.

Methods Prospective observational derivation study in ED patients with suspected infection. Prognostic performance of hs-cTnT (divided in four quartiles because of non-linearity) for prediction of inhospital mortality was assessed using multivariable logistic regression, correcting for predisposition, infection, response and organ failure (PIRO) score as a measure of illness severity and quality of ED treatment as quantified by the number of ‘Surviving Sepsis Campaign’ goals achieved. Discriminative power of hs-cTnT was assessed by receiver operator characteristics with area under the curve (AUC) analysis.

Results Hs-cTnT (median (IQR) was 57 (25–90) ng/L (n=23) in non-survivors, significantly higher than the 15 (7–28) ng/L in survivors (n=269, p<0.001). Additionally, the lowest quartile of hs-cTnT was a perfect predictor of survival because zero death occurred. Therefore, the second quartile was used as a reference category in the multivariable logistic regression analysis showing that hs-cTnT was an independent predictor of inhospital mortality: Corrected ORs were 2.2 (95% CI 0.4 to 12.1) and 5.8 (1.2 to 27.3) for the 3rd and 4th quartile compared with the 2nd hs-cTnT quartile. The AUCs of hs-TnT was 0.81 (0.74 to 0.88), similar to the AUC of 0.78 (0.68 to 0.87) of the PIRO score (p>0.05). Overall negative predictive value of hs-cTnT was 99%.

Conclusions In ED patients with suspected infection, the routinely used biomarker hs-cTnT is an independent predictor of inhospital mortality with excellent discriminative performance. Future studies should focus on the additional value of hs-cTnT to existing risk stratification tools.

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