Long-term prognostic significance of elevated cardiac troponin levels in critically ill patients with acute gastrointestinal bleeding

Background. Elevations in troponin level have prognostic importance in critically ill patients, including those with gastrointestinal (GI) bleeding. However, there are no data addressing the independent association of troponin levels and mortality, adjusted for the severity of the underlying disease, in patients with GI bleeding. Objective: This study was designed to determine whether troponin T elevations are independently associated with in-hospital, short-term (30 days), and long-term mortality in medical intensive care unit patients with GI bleeding after adjusting for the severity of disease measured by the Acute Physiology, Age, and Chronic Health Evaluation score prognostic system. Design: Retrospective study. Setting: We examined the Acute Physiology, Age, and Chronic Health Evaluation III database and cardiac troponin T levels from patients consecutively admitted to the medical intensive care unit at Mayo Clinic, Rochester, MN, with acute GI bleeding. Patients: Between August 2000 and July 2005, 1076 patients with acute GI bleeding consecutively admitted to the medical intensive care units. Measurements: In-hospital, short-term (30 days), and long-term all-cause mortality. Results: During hospitalization, 8.0% of deaths occurred in patients with troponin T <0.01% and 11.9% with troponin T >= 0.01 (p = 0.083). At 30 days, mortality was 10.1% and 18.8% in patients without and with elevations of troponins, respectively (p < 0.001). The Kaplan-Meier expected probability of survival at 1-, 2-., and 3-yr follow-up was 54.2%, 40.8%, and 30.4% with troponin T >= 0.01 mu g/L and 78.3%, 69.3%, and 61.5% with troponin T <0.01 mu g/L (p < 0.001). After adjustment for severity of disease and baseline characteristics, cardiac troponin levels were associated only with long-term mortality (p < 0.001). Limitations: This is a retrospective, single-center study which included only patients in whom troponin level was determined upon admission. Conclusions. In patients with GI bleeding severe enough to require admission to the medical intensive care unit, admission troponin T elevations are associated with long-term but not short-term mortality. (Crit Care Med 2009; 37:140-147)