Association between Troponin Level and Medium Term Mortality in 20,000 Hospital Patients

Jonathan Hinton, Mark Mariathas, Lavinia Gabara, Rick Allan, Zoe Nicholas, Chun Shing Kwok, Sanjay Ramamoorthy, Alison Calver, Simon Corbett, Richard J. Jabbour, Michael Mahmoudi, John Rawlins, Rohit Sirohi, James Richard Wilkinson, Paul Cook, Glen P. Martin, Mamas A. Mamas, Nick Curzen

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Cardiac troponin (cTn) concentrations above the manufacturer recommended upper limit of normal (ULN) are frequently seen in hospital patients without a clinical presentation consistent with type 1 myocardial infarction, and the significance of this is uncertain. The aim of this study was to assess the relationship between medium term mortality and cTn concentration in a large consecutive hospital population, regardless of whether there was a clinical indication for performing the test.
Method: This prospective observational study included 20,000 consecutive in-hospital and outpatient patients who had a blood test for any reason at a large teaching hospital, and in whom a hs-cTnI assay was measured, regardless of the original clinical indication. Mortality was obtained via NHS Digital.
Results: A total of 20,000 patients were included in the analysis and 18,282 of these (91.4%) did not have a clinical indication for cTnI testing. Overall, 2825 (14.1%) patients died at a median of 809 days. The mortality was significantly higher if the cTnI concentration was above the ULN (45.3% versus 12.3% p<0.001 log rank). Multivariable Cox analysis demonstrated that the log10 cTnI concentration was independently associated with mortality (hazard ratio 1.76 (95% confidence interval 1.65 – 1.88)). Landmark analysis, excluding deaths within 30 days, showed the relationship between cTnI concentration and mortality persisted.
Conclusion: In a large, unselected hospital population, in 91.4% of whom there was no clinical indication for testing, cTnI concentration was independently associated with medium term cardiovascular and non-cardiovascular mortality in the statistical model tested.
Original languageEnglish
JournalHeart
Publication statusAccepted/In press - 21 Jun 2023

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