Highly-sensitive troponin I in patients admitted to the emergency room with acute infections

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Zusammenfassung. Verbessertes Verständnis der menschlichen Physiologie und technische Fortschritte haben zu einer breiten Verwendung von Labordiagnostik in der klinischen Aufarbeitung eines Patienten geführt. Diese Entwicklungen gingen jedoch mit der Verbreitung von falschen Mythen und Missverständnissen einher, die humane und ökonomische Ressourcen konsumieren sowie das klinische Denken und – nicht zuletzt – den Patienten gefährden. Das Ziel dieses Artikels ist es daher, eine Übersicht über typische Beispiele von falschen Dogmen über in der Notfallmedizin häufig verwendete Laborwerte zu geben.

"Real life use" of troponin in the emergency department: a survey of over 3000 cases

INTRODUCTION

The aim of this study was to identify clinical variables which may be independently associated with positivity of a cardiac troponin I (cTnI) assay in a large population of patients admitted to the emergency department (ED).

MATERIALS AND METHODS

3166 subjects, with at least two troponin I tests ordered within 6 hours in the ED, were studied. Patient data were statistically analyzed to identify clinical associations with increased values of Troponin I.

RESULTS

Although patients with diagnosis of acute coronary syndrome displayed troponin I values significantly higher than those of other groups, positivity to troponin I (>40 ng/L) was also observed in patients with other clinical conditions. In multivariate analysis, age, elevated heart rate and electrocardiographic changes were independently associated with troponin I positivity at admission. In the whole study population troponin I positivity exhibited high sensitivity and negative predictive value, counterbalanced by low specificity and limited positive predictive value.

CONCLUSIONS

Troponin I positivity should be combined with history and clinical evaluation and cautiously interpreted in the ED, especially in patients exhibiting factors associated with higher troponin I levels such as older age, elevated heart rate or ECG changes.