Elevation of cardiac troponin I during non-exertional heat-related illnesses in the context of a heatwaveReport as inadecuate




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Critical Care

, 14:R99

First Online: 27 May 2010Received: 31 December 2009Revised: 31 March 2010Accepted: 27 May 2010

Abstract

IntroductionThe prognostic value of cardiac troponin I cTnI in patients having a heat-related illness during a heat wave has been poorly documented.

MethodsIn a post hoc analysis, we evaluated 514 patients admitted to emergency departments during the August 2003 heat wave in Paris, having a core temperature >38.5°C and who had analysis of cTnI levels. cTnI was considered as normal, moderately elevated abnormality threshold to 1.5 ng.mL, or severely elevated >1.5 ng.mL. Patients were classified according to our previously described risk score high, intermediate, and low-risk of death.

ResultsMean age was 84 ± 12 years, mean body temperature 40.3 ± 1.2°C. cTnI was moderately elevated in 165 32% and severely elevated in 97 19% patients. One-year survival was significantly decreased in patients with moderate or severe increase in cTnI 24 and 46% vs 58%, all P < 0.05. Using logistic regression, four independent variables were associated with an elevated cTnI: previous coronary artery disease, Glasgow coma scale <12, serum creatinine >120 μmol.L, and heart rate >110 bpm. Using Cox regression, only severely elevated cTnI was an independent prognostic factor hazard ratio 1.93, 95% confidence interval 1.35 to 2.77 when risk score was taken into account. One-year survival was decreased in patients with elevated cTnI only in high risk patients 17 vs 31%, P = 0.04.

ConclusionscTnI is frequently elevated in patients with non-exertional heat-related illnesses during a heat wave and is an independent risk factor only in high risk patients where severe increase >1.5 ng.mL indicates severe myocardial damage.

AbbreviationsADLactivities of daily living

cTnIcardiac troponin I

EDemergency department

ICUintensive care unit

ROCreceiver-operating characteristic

SDstandard deviation

Electronic supplementary materialThe online version of this article doi:10.1186-cc9034 contains supplementary material, which is available to authorized users.

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Author: Pierre Hausfater - Benoît Doumenc - Sébastien Chopin - Yannick Le Manach - Aline Santin - Sandrine Dautheville - Anabela 

Source: https://link.springer.com/







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