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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Many reports have shown that there is an association between acute myocardial injury and adverse outcomes in almost every clinical setting.
Research motivation
Data from consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and acute myocardial injury are limited.
Research objectives
To investigate: (1) The in-hospital survival of consecutive elderly patients presenting to the emergency department with acute non-cardiac events, elevated high-sensitivity cardiac troponin I (hs-cTnI) levels and admitted to the Internal Medicine Department; and (2) The independent predictors (i.e., comorbidities) of in-hospital mortality.
Research methods
This was a single centre, retrospective, observational study, involving 146 elderly (≥ 65 years) patients (59% female) admitted to the Internal Medicine Department with acute non-cardiac events and elevated hs-cTnI (≥ 100 ng/L).
Research results
Patient age ranged from 65 to 100 (mean ± SD: 85.4 ± 7.61) years. The median hs-cTnI value was 284.2 ng/L. The overall in-hospital mortality was 32% (47 patients). Multivariate 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.
Research conclusions
Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons and indicates poor overall prognosis. The presence of severe renal impairment remains as an independent marker of extremely high in-hospital mortality in this selected patient group.
Research perspectives
Our results emphasize the need for more aggressive monitoring and treatment in elderly patients with severe renal impairment admitted to the hospital for non-cardiac reasons in order to avoid complications and death.
