BibTex format
@article{Kaura:2019:10.1136/bmj.l6055,
author = {Kaura, A and Panoulas, V and Glampson, B and Davies, J and Mulla, A and Woods, K and Omigie, J and Shah, A and Channon, K and Weber, J and Thursz, M and Elliott, P and Hemingway, H and Williams, B and Asselbergs, F and OSullivan, M and Kharbanda, R and Lord, G and Melikian, N and Patel, R and Perera, D and Shah, A and Francis, D and Mayet, J},
doi = {10.1136/bmj.l6055},
journal = {BMJ-British Medical Journal},
title = {Association of troponin level and age with mortality in 250 000 patients: cohort study across five UK acute care centres},
url = {http://dx.doi.org/10.1136/bmj.l6055},
volume = {367},
year = {2019}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - ObjectiveTo determine the relation between age and troponinlevel and its prognostic implication.DesignRetrospective cohort study.SettingFive cardiovascular centres in the UK National Institutefor Health Research Health Informatics Collaborative(UK-NIHR HIC).Participants257948 consecutive patients undergoing troponintesting for any clinical reason between 2010 and2017.Main outcome measureAll cause mortality.Results257948 patients had troponin measured during thestudy period. Analyses on troponin were performedusing the peak troponin level, which was the highesttroponin level measured during the patient’s hospitalstay. Troponin levels were standardised as a multipleof each laboratory’s 99th centile of the upper limitof normal (ULN). During a median follow-up of 1198days (interquartile range 514-1866 days), 55850(21.7%) deaths occurred. A positive troponin result(that is, higher than the upper limit of normal)signified an overall 3.2-fold higher mortality hazard(95% confidence interval 3.1-fold to 3.2-fold) overthree years. The mortality hazard varied markedly withage, from 10.6-fold (8.5-fold to 13.3-fold) in 18-29year olds to 1.5 (1.4 to 1.6) in those older than 90.A positive troponin result was associated with anapproximately 15 percentage points higher absolutethree year mortality across all age groups. The excessmortality with a positive troponin result was heavilyconcentrated in the first few weeks. Results wereanalysed using multivariable adjusted restrictedcubic spline Cox regression. A direct relation wasseen between troponin level and mortality in patientswithout acute coronary syndrome (ACS, n=120049),whereas an inverted U shaped relation was foundin patients with ACS (n=14468), with a paradoxicaldecline in mortality at peak troponin levels >70xULN.In the group with ACS, the inverted U shaped relationpersisted after multivariable adjustment in those whowere managed invasively; however, a direct positiverelation was found between troponin level
AU - Kaura,A
AU - Panoulas,V
AU - Glampson,B
AU - Davies,J
AU - Mulla,A
AU - Woods,K
AU - Omigie,J
AU - Shah,A
AU - Channon,K
AU - Weber,J
AU - Thursz,M
AU - Elliott,P
AU - Hemingway,H
AU - Williams,B
AU - Asselbergs,F
AU - OSullivan,M
AU - Kharbanda,R
AU - Lord,G
AU - Melikian,N
AU - Patel,R
AU - Perera,D
AU - Shah,A
AU - Francis,D
AU - Mayet,J
DO - 10.1136/bmj.l6055
PY - 2019///
SN - 1756-1833
TI - Association of troponin level and age with mortality in 250 000 patients: cohort study across five UK acute care centres
T2 - BMJ-British Medical Journal
UR - http://dx.doi.org/10.1136/bmj.l6055
UR - http://hdl.handle.net/10044/1/74983
VL - 367
ER -