Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes

J Am Coll Cardiol. 2003 Jun 4;41(11):2004-9. doi: 10.1016/s0735-1097(03)00421-2.


Objectives: We sought to assess the mechanism and prognostic value of elevated troponins in patients without acute coronary syndromes (ACS).

Background: Cardiac troponins are used as specific markers for the diagnosis of ACS. Recent studies reported a considerable number of critically ill patients without ACS as being troponin-positive, especially patients with sepsis, pulmonary embolism, renal failure, and stroke.

Methods: We analyzed 58 consecutive, critically ill patients admitted for reasons other than ACS, according to their troponin status. Thirty-day mortality, left ventricular ejection fraction (LVEF), and a panel of inflammatory cytokines were compared between troponin-positive and troponin-negative patients. Relevant coronary artery disease was excluded either by stress echocardiography or autopsy.

Results: Of the 58 critically ill patients, 32 (55%) without evidence of ACS were troponin-positive. Positive troponin levels were associated with higher mortality (22.4% vs. 5.2%, p < 0.018) and a lower LVEF (p = 0.0006). Troponin-positive patients had significantly higher median levels of tumor necrosis factor (TNF)-alpha, its soluble receptor, and interleukin (IL)-6. A subgroup of 10 aplastic patients was troponin-negative at study entry. Three became troponin-positive during leukocyte recovery and subsequently died, whereas all the others stayed troponin-negative and survived. Flow-limiting coronary artery disease was not demonstrable at autopsy or stress echocardiography in 72% of troponin-positive patients.

Conclusions: Elevated troponin is a mortality risk factor for medical intensive care patients admitted for reasons other than ACS. It is associated with decreased left ventricular function and higher levels of TNF-alpha and IL-6.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Biomarkers / blood
  • Coronary Angiography
  • Coronary Disease / blood*
  • Coronary Disease / epidemiology*
  • Critical Illness / mortality
  • Cytokines / metabolism
  • Echocardiography, Stress
  • Female
  • Gram-Negative Bacterial Infections / blood
  • Gram-Negative Bacterial Infections / mortality
  • Gram-Positive Bacterial Infections / blood
  • Gram-Positive Bacterial Infections / mortality
  • Humans
  • Male
  • Middle Aged
  • Neutrophils / physiology
  • Risk Factors
  • Shock, Septic / blood
  • Shock, Septic / mortality
  • Stroke Volume / physiology
  • Survival Analysis
  • Syndrome
  • Time Factors
  • Troponin / blood*


  • Biomarkers
  • Cytokines
  • Troponin