Effectiveness of high-sensitivity troponin I to predict cardiovascular events in chest trauma patients

TL;DR

This study finds that high-sensitivity troponin I testing in chest trauma patients has limited value for predicting heart complications, with age and injury severity being better indicators.

Contribution

The study evaluates the predictive value of high-sensitivity troponin I in chest trauma patients and challenges its clinical utility in this specific population.

Findings

Initial high-sensitivity troponin I had moderate predictive value (AUROC 0.74) for cardiac complications.

Neither initial troponin I nor its change predicted complications in a multivariate model.

Age and SAPS II scores were stronger predictors of complications and mortality.

Abstract

Chest trauma accounts for nearly one-third of severe trauma cases and is associated with cardiac complications that increase morbidity and mortality. The utility of repeated high-sensitivity troponin I (hsTnI) testing in this context remains uncertain, particularly with the advent of ultra-sensitive assays.

We conducted a retrospective cohort study of 1,749 intensive care patients with chest trauma who underwent hsTnI testing. Cardiac complications during intensive care hospitalisation and 30-day mortality were recorded. Predictive performance of initial hsTnI was assessed using receiver operating characteristic curve (ROC) analysis, and associations between hsTnI values (initial and dynamic changes) and complications were tested in a multivariate logistic regression model adjusted for age and severity (SAPS II Score).

Cardiac complications occurred in 64 patients (3.7%), most frequently arrhythmias (1.6%). Initial hsTnI showed moderate predictive value (AUROC 0.74), with a threshold of 12.9 ng/L providing 73% sensitivity and 71% specificity. Patients with complications were older, had higher SAPS II scores, prolonged ICU stays, greater need for organ support, and increased 30-day mortality. In a multivariate model, neither initial hsTnI nor its variation independently predicted complications, whereas age and SAPS II remained significant predictors.

Cardiac complications after thoracic trauma are infrequent but strongly associated with adverse outcomes. Initial hsTnI offers only moderate prognostic performance, and a second testing does not improve risk stratification. Age and severity scores are stronger predictors of complications in this setting.

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