Chest
Clinical Investigations in Critical CareClinically Recognized Cardiac Dysfunction: An Independent Determinant of Mortality Among Critically III Patients: Is There a Role for Serial Measurement of Cardiac Troponin I?
Section snippets
Study Location and Population
The study was conducted within the medical ICU (19 beds) of Barnes-Jewish Hospital, St. Louis, a private teaching hospital with 1,300 medical ICU admissions per year. All patients admitted to the medical ICU during a 3-month period (April 1995 to June 1995) were evaluated prospectively. The nursing staff and physicians providing care for the patients in the medical ICU were completely blinded to the nature of this investigation. The study protocol was approved by the Human Studies Committee of
Patient Population
A total of 260 eligible patients requiring medical ICU admission were evaluated during the study period. The mean age of the study population was 58.5±18.6 years and 49.2% were female. Baseline demographic information and hospital mortality according to the presence or absence of clinically recognized cardiac dysfunction are shown in Table 1. Patients with clinically recognized cardiac dysfunction were significantly older (p=0.007), had greater APACHE II scores (p<0.001), and were more likely
DISCUSSION
Our main observation was that the occurrence of clinically recognized cardiac dysfunction is common (21.2%) among critically ill medical patients and is an independent determinant of hospital mortality. The finding of acute cardiac injury, assessed using serial blood measurements of cardiac troponin I, was also common (15.8%) but did not independently contribute to hospital mortality. We also demonstrated that severity of illness as assessed by APACHE II was not a good discriminator for the
ACKNOWLEDGMENTS
The authors wish to thank Daniel P. Schuster, MD, for his review of this manuscript.
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This work was supported in part by a grant from the American Lung Association of eastern Missouri.