Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2021; 13(10): 566-573
Published online Oct 26, 2021. doi: 10.4330/wjc.v13.i10.566
Elderly patients with non-cardiac admissions and elevated high-sensitivity troponin: the prognostic value of renal function
Ioanna Samara, Stavroula Tsiara, Michail I Papafaklis, Konstantinos Pappas, Georgios Kolios, Nikolaos Vryzas, Lampros K Michalis, Eleni T Bairaktari, Christos S Katsouras
Ioanna Samara, Michail I Papafaklis, Konstantinos Pappas, Nikolaos Vryzas, Lampros K Michalis, Christos S Katsouras, Second Department of Cardiology, University Hospital of Ioannina, Ioannina 45110, Greece
Stavroula Tsiara, Second Department of Internal Medicine, University Hospital of Ioannina, Ioannina 45110, Greece
Georgios Kolios, Laboratory of Biochemistry, University Hospital of Ioannina, Ioannina 45110, Greece
Eleni T Bairaktari, Laboratory of Clinical Chemistry, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece
Author contributions: Samara I, Katsouras CS, Tsiara S, and Papafaklis MI wrote the first draft; all authors were involved in data collection, analysis, interpretation, final drafting of this manuscript and contributed to the submission.
Institutional review board statement: The study was reviewed and approved by the University Hospital of Ioannina Institutional Review Board, No. 123, 25-02-2019 / 6303.
Informed consent statement: Signed informed consent form was not needed for this study, University Hospital of Ioannina has given permission to conduct this study.
Conflict-of-interest statement: None of the authors has any conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christos S Katsouras, MD, PhD, Associate Professor, Second Department of Cardiology, University Hospital of Ioannina, Stavros Niarchos avenue, Ioannina 45110, Greece. cskats@yahoo.com
Received: April 25, 2021
Peer-review started: April 25, 2021
First decision: June 17, 2021
Revised: June 27, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: October 26, 2021
Processing time: 178 Days and 14.4 Hours
Abstract
BACKGROUND

High-sensitivity cardiac troponin (hs-cTn) levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events. However, most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.

AIM

To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.

METHODS

In this retrospective study, we selected patients who were aged ≥ 65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons. Eligible patients were those who had hs-cTnI concentrations ≥ 100 ng/L. We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.

RESULTS

One hundred and forty-six patients (59% female) were selected with an age range from 65 to 100 (mean ± SD: 85.4 ± 7.61) years. The median hs-cTnI value was 284.2 ng/L. For 72 (49%) patients the diagnosis of hospitalization was an infectious disease. The overall in-hospital mortality was 32% (47 patients). Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive (median: 314.8 vs 282.5 ng/L; P = 0.565). There was no difference in mortality in patients with infectious vs non-infectious disease (29% vs 35%). Multivariable analysis showed that age (OR 1.062 per 1 year increase, 95%CI: 1.000-1.127; P = 0.048) and creatinine levels (OR 2.065 per 1 mg/dL increase, 95%CI: 1.383-3.085; P < 0.001) were the only independent predictors of death. Mortality was 49% in patients with eGFR < 30 mL/min/1.73 m2.

CONCLUSION

Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons. The presence of severe renal impairment is a marker of extremely high in-hospital mortality.

Keywords: Internal medicine; High sensitivity troponin; Elderly; Non-cardiac admissions; Renal function; Prognosis

Core Tip: Many reports have shown that there is an association between acute myocardial injury and adverse outcomes in almost every clinical setting. However, data from consecutive elderly patients admitted to Internal Medicine Departments with acute non-cardiac events are limited. We found that these patients are at high risk of in-hospital death and that age and renal dysfunction were the only independent predictors of death. Elderly patients with acute myocardial injury from non-cardiac cause and chronic kidney disease stages IV or V had an extremely high risk (approximate 50%) of in-hospital death.