Prognostic value of cardiac troponin I assay in hospitalized elderly patients
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Francesca Attanasio1, Pamela Carrer2, Anna Zurlo1
1Geriatrics Division, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
Insights
Cardiac troponin I (cTnI) levels in elderly inpatients predict mortality risk up to 6 months post-discharge. Elevated cTnI was a significant risk factor for 6-month mortality but not at 2 years in this population.
Area of Science:
- Geriatric Medicine
- Cardiology
- Clinical Biomarkers
Background:
- Cardiac troponin I (cTnI) in elderly inpatients remains understudied.
- Understanding cTnI's role in this demographic is crucial for risk stratification.
Purpose of the Study:
- To assess factors influencing cTnI levels in hospitalized elderly patients.
- To determine the prognostic value of cTnI for mortality in this group.
Main Methods:
- 354 elderly patients (mean age 84.8 years) admitted to a Geriatrics Division were monitored.
- In-hospital cTnI levels were measured, and patient mortality at 6 months and 2 years was recorded.
Main Results:
- In-hospital cTnI levels did not significantly differ between patients who died in-hospital and survivors.
- Elevated in-hospital cTnI levels were a significant mortality risk factor within 6 months post-discharge (HR 1.13).
- This association between cTnI and mortality was not observed at the 2-year follow-up.
Conclusions:
- Cardiac troponin I serves as a valuable risk stratification tool for 6-month mortality in elderly inpatients.
- The prognostic significance of cTnI diminishes by 2 years post-hospitalization in this population.
- Potential factors include reduced physiological reserves and conservative management in older patients.
Background:
Cardiac troponin I (cTnI) has been poorly studied in elderly inpatients.
Aim:
This study wanted to assess factors influencing the increase in cTnI and its prognostic value in hospitalized elderly patients.
Methods:
354 elderly (mean age of 84.8 ± 6.9 years) patients consecutively admitted in the Geriatrics Division in Padua were tested for cTnI levels assay during the hospital stay. Number of subsequent patient deaths at 6 months and 2 years were registered.
Results:
Of the 354 patients, 27 (7.6%) died in hospital; their levels were not significantly higher or more frequently positive on cTnI than those of the remainder of the sample. 71 (20.01%) patients died within 6 months of being discharged, and in-hospital positive cTnI levels emerged as a mortality risk factor in this group [unadjusted HR 1.13 (1.04-1.23); p = 0.004]. At 2 years, a total of 174 patients (49.2%) had died, but in-hospital pathological cTnI levels were not a mortality risk factor in this group.
Discussion:
It should be noted that cTnI level was a risk factor for mortality at 6 months but no longer at 2 years after an elderly patient's hospitalization. This finding may relate to patients' limited physiological reserves or be driven by the fact that the elderly tend to receive fewer evidence-based treatments, and to be managed more conservatively than younger patients.
Conclusions:
In the multidimensional analysis of older patients, troponin I can be used to stratify patients and assess mortality risk at 6 months, but not at 2 years.
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