Role of Troponin-I in Predicting Length of ICU Stay in Post-Cardiac Surgery Patients: Role of Troponin-I in Predicting Length of ICU Stay

Wardah  Saleem; Ikram  Hassan; Fayaz  Iqbal; Fatima  Saleem

doi:10.54393/pjhs.v4i04.646

Authors

Wardah Saleem National Institute of Cardiovascular Diseases, Karachi, Pakistan
Ikram Hassan National Institute of Cardiovascular Diseases, Karachi, Pakistan
Fayaz Iqbal Lady Reading Hospital, Peshawar, Pakistan
Fatima Saleem Rehman Medical Institute, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v4i04.646

Keywords:

Post-Operative Troponin Levels, Cardiac Surgery, ICU Stay, Troponin I

Abstract

The cardiac surgery procedures are associated with a release of enzyme troponin from the heart muscles. These troponin levels can be used to predict the post-operative outcomes. Objective: To find out the relationship between troponin I levels and length of ICU stay after open heart surgery. Methods: A total of 200 patients’ data were collected from January to August 2022 at the cardiac surgery department of National Institute of Cardiovascular Diseases, Karachi. The study was conducted after the approval of Ethical Research Committee. Demographic characteristics of patients, procedure details and post-operative course was taken into account for this study. The troponin I levels were sent 12 hours after the surgery and their effect on ICU stay was studied. Results: The post-operative troponin levels were divided into different sets. There were 61% patients with troponin- I levels less than 9 ng/ml, 28% patients with troponin-I levels between 9 – 18 ng/ml and 11% patients with troponin-I levels of more than 18ng/ml. There was no difference in ICU stay between patients having troponin levels < 18ng/ml. They were all stable and their ICU stay comprised of 24 hours only. Whereas, in the group of patients having troponin levels > 18 ng/ml, the ICU stay was prolonged, extending to 48 - 72 hours. Conclusions: Serum Troponin levels can be used to predict the length of ICU stay. Higher Troponin levels > 18 ng/ml are associated with a prolonged ICU stay of more than 24 hours

References

MedlinePlus. Heart Attack. 2020. [Last cited: 1st Jul 2020]. Available from: https://medlineplus.gov/heartattack.html.

Charley M. Elevated troponin levels after CABG. 2022 [Last cited: 23rd Sep 2022]. Available from: https://www.clicktocurecancer.info/cardiac-troponin/elevated-troponin-levels-after-cabg.html.

Nesher N, Alghamdi AA, Singh SK, Sever JY, Christakis GT, Goldman BS, et al. Troponin after cardiac surgery: a predictor or a phenomenon? The Annals of Thoracic Surgery. 2008 Apr; 85(4): 1348-54. doi: 10.1016/j.athoracsur.2007.12.077.

Devereaux PJ, Lamy A, Chan MTV, Allard RV, Lomivorotov VV, Landoni G, et al. High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality. The New England Journal of Medicine. 2022 Mar; 386(9): 827-36. doi: 10.1056/NEJMoa2000803.

Jo MS, Lee J, Kim SY, Kwon HJ, Lee HK, Park DJ, et al. Comparison between creatine kinase MB, heart-type fatty acid-binding protein, and cardiac troponin T for detecting myocardial ischemic injury after cardiac surgery. Clinica Chimica Acta. 2019 Jan; 488: 174-8. doi: 10.1016/j.cca.2018.10.040.

Tidy C. Cardiac Enzymes and Markers for Myocardial Infarction. 2019. [Last cited: 23rd Mar 2022]. Available at: https://patient.info/doctor/cardiac-enzymes-and-markers-for-myocardial-infarction.

Themes UFO. The intensive care unit. 2016. [Last cited: 23rd Sep 2022]. Available at: https://aneskey.com/the-intensive-care-unit/.

Lurati Buse GA, Koller MT, Grapow M, Bolliger D, Seeberger M, Filipovic M. The prognostic value of troponin release after adult cardiac surgery—a meta-analysis. European Journal of Cardio-Thoracic Surgery. 2010 Feb; 37(2): 399-406. doi: 10.1016/j.ejcts.2009.05.054.

Omran H, Deutsch MA, Groezinger E, Zittermann A, Renner A, Neumann JT, et al. High-sensitivity cardiac troponin I after coronary artery bypass grafting for post-operative decision-making. European Heart Journal. 2022 Jul; 43(25): 2388-403. doi: 10.1093/eurheartj/ehab918.

Paccalet A, Crola Da Silva C, Mechtouff L, Amaz C, Varillon Y, De Bourguignon C, et al. Serum soluble tumor necrosis factor receptors 1 and 2 are early prognosis markers after st-segment elevation myocardial infarction. Frontiers in Pharmacology. 2021 Sep; 12: 656928. doi: 10.3389/fphar.2021.656928.

Tevaearai Stahel HT, Do PD, Klaus JB, Gahl B, Locca D, Göber V, et al. Clinical relevance of troponin T profile following cardiac surgery. Frontiers in Cardiovascular Medicine. 2018 Dec; 5: 182. doi: 10.3389/fcvm.2018.00182.

Su JA, Kumar SR, Mahmoud H, Bowdish ME, Toubat O, Wood JC, et al. Postoperative serum troponin trends in infants undergoing cardiac surgery. Seminars in Thoracic and Cardiovascular Surgery. 2019 Jun; 31(2): 244-251. doi: 10.1053/j.semtcvs.2018.08.010.

Al-Sarraf N, Thalib L, Hughes A, Houlihan M, Tolan M, Young V, et al. Cross-clamp time is an independent predictor of mortality and morbidity in low-and high-risk cardiac patients. International Journal of Surgery. 2011 Jan; 9(1): 104-9. doi: 10.1016/j.ijsu.2010.10.007.

Brown JR, Hernandez F, Klemperer JD, Clough RA, DiPierro FV, Hofmaster PA, et al. Cardiac troponin T levels in on-and off-pump coronary artery bypass surgery. Heart Surgery Forum. 2007 Jan 1; 10(1): 12. doi: 10.1532/HSF98.20061105.

Lehrke S, Steen H, Sievers HH, Peters H, Opitz A, Muller-Bardorff M, et al. Cardiac troponin T for prediction of short-and long-term morbidity and mortality after elective open heart surgery. Clinical Chemistry. 2004 Sep; 50(9): 1560-7. doi: 10.1373/clinchem.2004.031468.

Chung JZ and Jones GR. Effect of renal function on serum cardiac troponin T—population and individual effects. Clinical Biochemistry. 2015 Aug; 48(12): 807-10. doi: 10.1016/j.clinbiochem.2015.05.004.

Lim W, Qushmaq I, Cook DJ, Crowther MA, Heels-Ansdell D, Devereaux PJ. Elevated troponin and myocardial infarction in the intensive care unit: a prospective study. Critical Care. 2005 Dec; 9(6): 1-9. doi: 10.1186/cc3816.

McLean AS, Tang B, Nalos M, Huang SJ, Stewart DE. Increased B-type natriuretic peptide (BNP) level is a strong predictor for cardiac dysfunction in intensive care unit patients. Anaesthesia and Intensive Care. 2003 Feb; 31(1): 21-7. doi: 10.1177/0310057X0303100104.

Fonarow GC, Peacock WF, Horwich TB, Phillips CO, Givertz MM, Lopatin M, et al. Usefulness of B-type natriuretic peptide and cardiac troponin levels to predict in-hospital mortality from ADHERE. The American Journal of Cardiology. 2008 Jan; 101(2): 231-7. doi: 10.1016/j.amjcard.2007.07.066.

Ahmed SH, Pervez N, Rehan ST, Shaikh TG, Waseem S. Postoperative cardiac troponin I as an indicator of surgical outcomes: A systematic review. Journal of Cardiac Surgery. 2022 Dec; 37(12): 5351-61. doi: 10.1111/jocs.17197.