NEW YORK (Reuters Health) Dec 24 - Elevated troponin T levels in patients with pulmonary embolism are associated with higher in-hospital and 1-year mortality, according to a report in the European Respiratory Journal for December.
A recent meta-analysis suggested an association between mortality and plasma levels of troponins in patients with acute pulmonary embolism, the researchers explain, but the predictive value of elevated troponins for adverse outcomes has remained unclear.
Dr. Karin M. Janata from the Medical University of Vienna, Austria, and colleagues investigated the relationship between troponin T (TNT) and survival in 737 patients diagnosed with pulmonary embolism.
During 1 year of follow-up, 44 (29%) of the TNT-positive patients died, compared with 42 (10%) of the TNT-negative patients.
The in-hospital death rate was 21% among TNT-positive patients, the authors report, but only 6% among TNT-negative patients.
For patients who survived the initial hospitalization, 1-year mortality was 10% in TNT-positive patients versus 5% in TNT-negative patients.
TNT independently predicted mortality after adjusting for cancer, immobility, and age, the investigators say, and after exclusion of initially hemodynamically unstable patients.
"Elevated TNT levels meant a four-times higher risk of in-hospital death and a three-times higher risk of 1-year mortality, even after adjustment for the other most important risk factors of death in this population," the authors report.
Although researchers should perform more trials to determine whether TNT-positive patients could benefit from thrombolysis, the authors conclude, TNT has the advantage of being an objective measure for a condition marked by "soft" subjective parameters.
Eur Respir J 2009;34:1357-1363.
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