Exploratory evaluation of the role of cardiac troponin on the clinical outcome of patients visiting emergency department with or without chronic kidney disease

Song, Minseok; Kang, Eun-Jin; Kim, Taerim; Park, Jong Eun; Lee, Gun Tak; Yoon, Hee; Hwang, Sung Yeon; Cha, Won Chul; Shin, Tae Gun; Sim, Min Seob; Jo, Ik Joon; Choi, Jin-Ho

J Korean Soc Emerg Med > Volume 32(6); 2021 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2021;32(6): 548-560.

Exploratory evaluation of the role of cardiac troponin on the clinical outcome of patients visiting emergency department with or without chronic kidney disease

Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence

Jin-Ho Choi ,Tel: 02-3410-3419, Fax: 02-3410-0317, Email: jhchoimd@gmail.com,

Received: July 21, 2020; Revised: October 13, 2020 Accepted: November 9, 2020. Published online: December 31, 2021.

ABSTRACT

Objective:
Elevated levels of cardiac troponin in chronic kidney disease (CKD) patients admitted to the emergency department (ED) is not well understood and is often ignored. This study aimed to investigate the impact of cardiac troponin I (TnI) levels on the clinical outcome of patients visiting the ED with or without CKD.
Method:
In this retrospective single-center cohort study, we enrolled patients visiting the ED without a diagnosis of coronary artery disease (CAD). Elevated cardiac TnI was defined as being ≥99th percentile of the normal population (Siemens ADVIA Centaur TnI-Ultra≥0.040 ng/mL). The clinical outcomes of patients with CKD stage≤2 and CKD stage ≥3 were compared. The primary endpoint was the 180-day all-cause death, including cardiovascular and non-cardiovascular deaths.
Results:
Among a total of 30,472 patients (median age, 61 years; male sex, 54.3%), elevated TnI was found in 4,377 patients (14.4%). There were 3,634 deaths (11.9%) including 584 cardiovascular (1.9%) and 3,050 non-cardiovascular deaths (10.0%). The risk of all-cause death increased in patients with elevated TnI in both CKD stage≤2 (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.9-2.3) and CKD stage≥3 (HR, 1.5; 95% CI, 1.4-1.7), and so did the risks of cardiovascular and non-cardiovascular death (HR, 1.2-4.7) (P<0.05, all). The association of elevated TnI with death risk was consistent in multivariate analyses and in most clinical subgroup analyses.
Conclusion:
Elevated TnI was associated with higher 180-day mortality irrespective of renal function among patients visiting the ED without documented CAD. CKD patients visiting the ED with elevated TnI may warrant additional evaluation or careful follow-up even without the presence of CAD.

Key words: Troponin; Chronic kidney disease; Emergency departments