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The value of admission Troponin I to predict outcomes in suspected infections in elderly patients admitted in Internal Medicine: results from the SOFA-T collaboration, a multi-center study

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Abstract

Elderly patients affected by suspected infection and declining clinical conditions can be admitted to stepdown units (SDU), but a risk stratification is necessary to optimize their management. Admission troponin I (aTnI) has a prognostic role, however, one of the most commonly used stratification tools, the Sequential Organ Failure Assessment score (SOFA), does not consider myocardial injury. With this paper, we aimed to evaluate the prognostic accuracy of a new score, named SOFA-T, considering both SOFA score and aTnI in a cohort of elderly patients admitted to the stepdown beds of two Internal Medicine departments. Patients aged > 65 years admitted in SDU of two different hospitals of the same region in a 12-months timeframe were retrospectively assessed obtaining age, sex, days of admission, in-hospital death, SOFA, aTnI and comorbidities. The best aTnI cutoff for in-hospital death was calculated with ROC curve analysis; dichotomous variables were compared with chi-squared test; continuous variables were compared with t test or Mann–Whitney test. We obtained a cohort of 390 patients. The best aTnI cutoff was 0.31 ng/ml: patients with increased aTnI had higher risk of in-hospital death (OR: 1.834; 95% CI 1.160–2.900; p = 0.009), and higher SOFA (6.81 ± 2.71 versus 5.97 ± 3.10; p = 0.010). Adding aTnI to SOFA increased significantly the area under the curve (AUCSOFA = 0.68; 95% CI 0.64–0.73; AUCSOFA-T = 0.71; 95% CI 0.65–0.76; p = 0.0001), with a slight improvement of the prognostic performance. In elderly patients admitted to SDU for suspected infection, sepsis or septic shock, aTnI slightly improves the accuracy of SOFA score of the in-hospital death prediction.

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The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Internal Medicine Department, INRCA-IRCCS Hospital, Osimo, Ancona, Italy

    N. Tarquinio, M. Martino, A. Fioranelli, C. Di Pentima, A. Martini & M. Burattini

  2. Clinica Di Neurologia, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” Di Ancona, Italy, Ancona, Italy

    G. Viticchi

  3. Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” Di Ancona, Via Conca 10, Ancona, Italy

    V. Zaccone, C. Nitti, A. Salvi & L. Falsetti

  4. Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy

    P. Morciano

  5. Clinica Medica, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” Di Ancona, Italy, Ancona, Italy

    G. Moroncini

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  1. N. Tarquinio
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Contributions

Conceptualization: LF and NT; methodology: LF, NT, MM; formal analysis and investigation: LF, NT, MM; writing—original draft preparation: LF, NT, MM, VZ, GV; writing—review and editing: MM, VZ, PM, GM, AF, CdP, AM, AS, CN, MB; data acquisition: MM, AF, CdP, AM; supervision: LF, NT, AS, MB.

Corresponding author

Correspondence to L. Falsetti.

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The authors declare that they have no conflict of interest.

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Ethical approval was waived by the Ethics Committees of both participating centres (INRCA Ethics Committee, Prot. N. 23533/19-CE and CERM Ethics Committee, Prot. N. 2019/387). In view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Tarquinio, N., Viticchi, G., Zaccone, V. et al. The value of admission Troponin I to predict outcomes in suspected infections in elderly patients admitted in Internal Medicine: results from the SOFA-T collaboration, a multi-center study. Intern Emerg Med 16, 981–988 (2021). https://doi.org/10.1007/s11739-020-02610-x

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