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Value of Cardiac Troponin I for Predicting In-Hospital Occurrence of Hypotension in Stable Patients with Acute Pulmonary Embolism.
MedLine Citation:
PMID:  23143066     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT: Although cardiac troponin I (cTnI) elevations during acute pulmonary embolism (PE) are predictive of in-hospital death, it is not clear whether cTnI measurements at emergency department (ED) admission are predictive of the occurrence of hypotension. The study subjects included all consecutive patients with acute PE (diagnosed by chest computed tomography angiography) in the ED between January, 2006 and December, 2011. All underwent cTnI tests at ED admission and were divided into two groups based on the occurrence of hypotension within 24 h. Of 457 stable patients with acute PE who were admitted to the ED during the study period, 301 patients were included. Within 24 h of hospitalization, 27 (9.0%) developed hypotension. The patients who developed hypotension had a significantly higher mean cTnI concentration than the remaining patients (1.01 vs. 0.14 ng/mL, P<0.00). They were also more likely to be treated with thrombolytic therapy and had higher 28-day and 6-month mortality rates. cTnI elevation (>0.05 ng/mL) at ED admission was a strong predictor of the development of hypotension within 24 h (odds ratio 8.2, 95% CI 2.6-26.1, p = 0.00). The sensitivity, specificity, positive predictive value, and negative predictive value of elevated cTnI were 85%, 66%, 20%, and 98%, respectively. This study suggests that a normal cTnI nearly rules out subsequent development of hypotension within 24 h. This may help to select those patients who would benefit most from intensive clinical surveillance and escalated treatment.
Authors:
Sang Ku Jung; Won Young Kim; Chang Hwan Sohn; Hui Dong Kang; Se Hyun Oh; Kyoung-Soo Lim; Sang-Bum Hong; Chae-Man Lim; Younsuck Koh
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-8
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  -     ISSN:  1540-0514     ISO Abbreviation:  Shock     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
a Department of Emergency Medicine, Ulsan University College of Medicine, Gangneung Asan Hospital, Gangneung, Korea b Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea c Pulmonary and Critical Care Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
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