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Association of troponin level and age with mortality in 250 000 patients: cohort study across five UK acute care centres.
The BMJ ( IF 105.7 ) Pub Date : 2019-11-21 00:00:00 , DOI: 10.1136/bmj.l6055
Amit Kaura 1 , Vasileios Panoulas 1 , Benjamin Glampson 1 , Jim Davies 2 , Abdulrahim Mulla 1 , Kerrie Woods 2 , Joe Omigie 3 , Anoop D Shah 4 , Keith M Channon 2 , Jonathan N Weber 1 , Mark R Thursz 1 , Paul Elliott 1, 5 , Harry Hemingway 4, 5 , Bryan Williams 4 , Folkert W Asselbergs 4 , Michael O'Sullivan 6 , Rajesh Kharbanda 2 , Graham M Lord 7 , Narbeh Melikian 3 , Riyaz S Patel 4 , Divaka Perera 8 , Ajay M Shah 3 , Darrel P Francis 1 , Jamil Mayet 9
Affiliation  

Objective To determine the relation between age and troponin level and its prognostic implication.
Design Retrospective cohort study.
Setting Five cardiovascular centres in the UK National Institute for Health Research Health Informatics Collaborative (UK-NIHR HIC).
Participants 257 948 consecutive patients undergoing troponin testing for any clinical reason between 2010 and 2017.
Main outcome measure All cause mortality.
Results 257 948 patients had troponin measured during the study period. Analyses on troponin were performed using the peak troponin level, which was the highest troponin level measured during the patient’s hospital stay. Troponin levels were standardised as a multiple of each laboratory’s 99th centile of the upper limit of normal (ULN). During a median follow-up of 1198 days (interquartile range 514-1866 days), 55 850 (21.7%) deaths occurred. A positive troponin result (that is, higher than the upper limit of normal) signified a 3.2 higher mortality hazard (95% confidence interval 3.1 to 3.2) over three years. Mortality varied noticeably with age, with a hazard ratio of 10.6 (8.5 to 13.3) in 18-29 year olds and 1.5 (1.4 to 1.6) in those older than 90. A positive troponin result was associated with an approximately 15 percentage points higher absolute three year mortality across all age groups. The excess mortality with a positive troponin result was heavily concentrated in the first few weeks. Results were analysed using multivariable adjusted restricted cubic spline Cox regression. A direct relation was seen between troponin level and mortality in patients without acute coronary syndrome (ACS, n=120 049), whereas an inverted U shaped relation was found in patients with ACS (n=14 468), with a paradoxical decline in mortality at peak troponin levels >70×ULN. In the group with ACS, the inverted U shaped relation persisted after multivariable adjustment in those who were managed invasively; however, a direct positive relation was found between troponin level and mortality in patients managed non-invasively.
Conclusions A positive troponin result was associated with a clinically important increased mortality, regardless of age, even if the level was only slightly above normal. The excess mortality with a raised troponin was heavily concentrated in the first few weeks.
Study registration ClinicalTrials.gov NCT03507309.



中文翻译:

肌钙蛋白水平和年龄与250000例患者的死亡率之间的关系:英国五个急救中心的队列研究。

目的探讨年龄与肌钙蛋白水平的关系及其预后意义。
设计回顾性队列研究。
设置在英国国家卫生研究所医疗信息协作(UK-NIHR HIC)五个心血管中心。
参与者2010年至2017年之间,由于任何临床原因,连续257948例患者接受了肌钙蛋白检测。
主要结果指标所有原因均导致死亡。
结果在研究期间测得257 948例肌钙蛋白。使用峰值肌钙蛋白水平进行肌钙蛋白分析,该水平是患者住院期间测得的最高肌钙蛋白水平。肌钙蛋白水平标准化为每个实验室正常上限(ULN)的第99个百分点的倍数。在中位随访1198天(四分位间距为514-1866天)期间,发生了55 850(21.7%)人死亡。肌钙蛋白阳性结果(即高于正常上限)表示三年内有3.2更高的死亡危险(95%置信区间3.1到3.2)。死亡率随年龄的变化而显着变化,18-29岁的人的危险比为10.6(8.5至13.3),而90岁以上的人的危险比为1.5(1.4至1.6)。肌钙蛋白阳性的结果与所有年龄组的绝对三年死亡率都高出约15个百分点。肌钙蛋白阳性的超额死亡率在最初几周内高度集中。使用多变量调整的限制性三次样条Cox回归分析结果。在没有急性冠脉综合征的患者中,肌钙蛋白水平与死亡率之间存在直接关系(ACS,n = 120049),而在ACS患者中,肌钙蛋白水平呈倒U型关系(n = 14468),死亡率呈反常下降在峰值肌钙蛋白水平> 70×ULN时。在ACS组中,经多变量调整后,那些进行了侵入性治疗的患者中,倒U形关系仍然存在。然而,
结论肌钙蛋白阳性结果与临床重要性的增加死亡率相关,而不论年龄大小,即使该水平仅略高于正常水平也是如此。肌钙蛋白升高引起的过高死亡率在头几周内集中集中。
研究注册ClinicalTrials.gov NCT03507309。

更新日期:2019-11-21
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