Changes and significance of serum troponin in trauma patients: A retrospective study in a level I trauma center

doi:10.5847/wjem.j.1920-8642.2022.016

Abstract

Abstract:

BACKGROUND: Elevated troponin I (TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, this study aims to explore the changes and clinical significance of serum TnI in trauma patients.
METHODS: The clinical data of consecutive trauma patients admitted to our trauma center between July 1, 2017 and July 31, 2020 were retrospectively analyzed. According to TnI levels within 24 hours of admission, patients were divided into the elevated and normal TnI groups. According to the TnI levels after 7 days of admission, a graph depicting a change in trend was drawn and then analyzed whether TnI was related to in-hospital mortality.
RESULTS: A total of 166 patients (69 and 97 cases with elevated and normal TnI, respectively) were included in this study. The average hospital stay, intensive care time, mechanical ventilation time, and in-hospital mortality were higher in the elevated TnI group than in the normal TnI group (P<0.05). The TnI level of trauma patients gradually increased after admission and peaked at 48 hours (7.804±1.537 ng/mL). Subsequently, it decreased, and then recovered to normal within 7 days. However, 13 patients did not recover. Logistic regression analysis revealed that abnormal TnI at 7 days was independently related to in-hospital mortality.
CONCLUSIONS: Trauma patients with elevated TnI levels may have a worse prognosis. Monitoring the changes in serum TnI is important, which can reflect the prognosis better than the TnI measured immediately after admission.

Key words: Trauma, Blunt cardiac injury, Troponin I, Electrocardiography

Li-wen Dou, Zhe Du, Ji-hong Zhu, Tian-bing Wang. Changes and significance of serum troponin in trauma patients: A retrospective study in a level I trauma center[J]. World Journal of Emergency Medicine, 2022, 13(1): 27-31.

Figures/Tables 4

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Parameters	Elevated TnI group (n=69)	Normal TnI group (n=97)	Statistics	P
Age, years	47.59±19.12	50.33±15.08	6.55	0.325
Male, n (%)	58 (84.04)	65 (67.01)	6.10	0.010
Injury Severity Score	31.62±14.55	19.16±8.26	25.26	0.000
Injury type, n (%)
Traumatic brain injury	30 (43.47)	37 (38.14)	0.48	0.298
Traumatic chest injury	49 (71.01)	50 (51.54)	6.34	0.009
Traumatic abdominal injury	26 (37.68)	23 (23.71)	3.46	0.046
Traumatic bone injury	52 (75.36)	56 (57.73)	4.78	0.021
Heart rate, beats/minute	98.94±25.43	82.40±15.30	27.80	0.000
Systolic blood pressure, mmHg	115.43±32.51	129.85±20.67	21.10	0.001
Hemoglobin, g/L	115.94±29.48	131.13±21.06	11.76	0.000
Creatinine, µmol/L	96.54±42.02	70.53±31.89	10.88	0.000
Lactic acid, mmol/L	3.56±2.96	1.49±0.98	43.61	0.000
Troponin, ng/mL	0.57±1.34	0.01±0.01	28.13	0.000
Creatine kinase-myocardial band, ng/mL	30.13±35.55	10.19±21.615	26.75	0.000
Myoglobin, ng/mL	1,196.30±1,289.60	269.38±321.65	97.38	0.000
ST-T changes, n	7	10	0.00	0.984
Right bundle branch block, n	2	5	0.50	0.478
QT interval prolongation, n	2	2	0.13	0.723
Supraventricular tachycardia, n	3	0	4.35	0.069
Atrial fibrillation, n	2	1	0.81	0.760
Sinus bradycardia, n	7	6	0.92	0.337
Sinus tachycardia, n	18	8	11.97	0.001
Premature beats, n	3	3	0.19	0.989
Valve regurgitation, n	13	10	0.08	0.776
Ventricular wall motion abnormalities, ventricular enlargement, n	2	0	1.43	0.510
Pericardial effusion, n	1	0	0.71	0.401
Hospitalization, days	23.39±26.08	13.15±8.54	18.84	0.000
Intensive care duration, days	20.70±26.06	7.89±6.83	20.11	0.000
Ventilator use time, hours	222.78±319.92	42.15±125.50	26.01	0.000
In-hospital mortality, n (%)	10 (14.49)	0 (0)	14.81	0.000

Parameters	Death group (n=10)	Survival group (n=156)	Statistics	P
Age, years	45.50±23.35	49.34±16.51	1.92	0.488
Male, n (%)	8 (80.00)	115 (73.71)	0.17	0.973
ISS score	41.56±21.23	23.18±11.88	9.87	0.000
Hemoglobin, g/L	112.90±34.17	126.07±25.09	1.49	0.117
Creatinine, µmol/L	122.00±75.75	77.94±33.41	27.60	0.000
Lactic acid, mmol/L	7.53±5.08	2.05±1.58	84.92	0.000
Troponin on admission, ng/mL	0.62±1.08	0.22±0.89	2.41	0.117
Abnormal troponin after 7 days, n	6	7	40.12	0.000
Number of blunt cardiac injury patients, n	10	30	33.52	0.000

Parameters	B value	Wald value	Odds ratio	95% confidence interval	P
Abnormal troponin at 7 days	-2.896	8.133	0.055	0.008-0.404	0.004
Troponin on admission	-3.263	1.253	0.038	0.000-11.604	0.263
Lactic acid level	0.466	0.212	1.594	1.053-2.413	0.028

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