Elevated cardiac troponin T in cirrhotic patients with emergency care admissions: Associations with mortality
Mayada Elnegouly1,2, Katrin Umgelter3, Wajima Safi4
12nd Medical Department, Technical University of Munich, Munich, Germany.
Insights
Elevated cardiac troponin T (cTnT) levels in emergency department patients with cirrhosis, even without heart disease, predict higher 1-year mortality. This finding aids in risk stratification for cirrhotic patients admitted to the ED.
Area of Science:
- Cardiology
- Hepatology
- Emergency Medicine
Background:
- High mortality rates in cirrhotic patients admitted to the emergency department (ED).
- Prognostic factors are crucial for prioritizing care in this population.
- Need to identify novel biomarkers for risk stratification in liver cirrhosis.
Purpose of the Study:
- To assess the association between cardiac troponin T (cTnT) levels and 1-year mortality.
- To evaluate cTnT as a prognostic factor in cirrhotic patients without known cardiac disease admitted to the ED.
Main Methods:
- Retrospective analysis of 237 cirrhotic ED patients from October 2009 to August 2015.
- Initial cTnT levels measured with the first lab panel.
- 365-day mortality follow-up, adjusting for Model for End-stage Liver Disease (MELD) and CLIF-C-ACLF scores.
Main Results:
- 49% of patients had elevated cTnT levels (>14 ng/L).
- Elevated cTnT and higher CLIF-C-ACLF scores were independently associated with increased 1-year mortality.
- Hazard ratio for cTnT: 1.014 per ng/L increase (P=0.008).
Conclusions:
- A significant proportion of cirrhotic ED patients exhibit elevated cTnT without cardiac disease.
- Elevated cTnT is a significant independent predictor of 1-year mortality in this cohort.
- cTnT may serve as a valuable prognostic marker in emergency settings for liver cirrhosis patients.
Background And Aim:
Mortality of cirrhotic patients after emergency care admission is high, and prognostic factors can help in prioritizing patients. The aim of our study was to assess the association between levels of cardiac troponin T (cTnT) and 1-year mortality in patients with liver cirrhosis without known cardiac disease, who were admitted to the emergency department (ED).
Methods:
All patients with cirrhosis presented to the ED from October 2009 until August 2015 who had an initial cTnT value measured with the first lab panel were retrospectively analyzed with a follow-up of 365 days.
Results:
Of a total of 237 cirrhotic ED patients, cTnT measurements were available for 87 (63% men, mean age 58.9 ± 11.0 years, and median Model for End-stage Liver Disease score was 15 [25th-75th percentile: 10-19]). Chronic Liver Failure Consortium acute-on-chronic liver failure (CLIF-C-ACLF) score was 33. Forty-three patients (49%) had cTnT values above the normal range (14 ng/L), of which 19 (22%) had values over 30 ng/L. Two patients were lost to follow-up. In multivariable analysis, both CLIF-C-ACLF (hazard ratio 1.072 per point increase; 95% confidence interval 1.029-1.117; P < 0.001) and cTnT (hazard ratio 1.014 per ng/L increase; 95% confidence interval 1.004-1.024; P = 0.008) emerged as independently associated with mortality.
Conclusions:
A large proportion of cirrhotic patients in the ED have elevated levels of cTnT even if there is no evidence of cardiac disease. Elevated cTnT is associated with increased mortality during 1 year after correcting for Model for End-stage Liver Disease and CLIF-C-ACLF scores.
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