Troponin T is a strong marker of mortality in hospitalized patients

Abstract

Background: Cardiac troponins are diagnostic markers in acute coronary syndrome and prognostic markers in stable coronary disease. Small increases are occasionally observed in patients with non-cardiac disease, but the prevalence and prognostic value of increased troponin in the general hospitalized population are unknown.

Methods: Consecutive patients aged >40 years admitted to a district hospital between 1 April 1998 and 31 March 1999 were included. A comprehensive medical interview and clinical examination were performed including echocardiography and measurement of natriuretic peptides and troponin T with a high-sensitivity assay (hs-TnT).

Results: Serum for analyses of hs-TnT was available from 1176 patients. Patients were 73.7 years old on average (interquartile range, 64.5-80.0 years), 59.2% were women and median follow-up was 11.4 years. The prevalence of elevated hs-TnT (> 99(th) percentile) was 57.1% of the entire cohort and 52.3% of patients with non-cardiac diagnoses. hs-TnT above the median (17 ng/L) was associated in univariate analysis with a 3-fold higher mortality in the entire population (multivariate hazard rate (HR) from 1.3 to 1.8 for 1 and 11 year mortality, respectively). In patients without past or present ischemic heart disease hs-TnT in the upper quartile (above 34.8 ng/L) was associated in univariate analysis with a 5-fold higher mortality risk (multivariable HR 1.8 to 2.2 for 1 and 11 year mortality, respectively).

Conclusion: More than half of the hospitalized patients had hs-TnT levels above the 99(th) percentile. Elevated hs-TnT is a strong mortality risk marker in general hospitalized older patients.

Keywords: Mortality; Natriuretic peptides; Troponin.