Factors associated with elevated cardiac troponin levels in patients with acute pulmonary thromboembolism

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We aimed to investigate the factors that are associated with increased cardiac troponin I (cTnI) leakage in the acute pulmonary embolism (PTE) setting and their alignment with patient outcome.


Adult patients with a diagnosis of PTE were enrolled in this prospective cohort study. The primary endpoint of interest was major adverse cardio-pulmonary events (MACPE), defined as the composite of in-hospital all-cause mortality, need for thrombolysis and mechanical ventilation and surgical embolectomy during index hospitalization. Multivariable regression analysis is used to assess factors associated with MACPE.


16.6% of 627 patients with acute PTE, had elevated serum cTnI. MACPE occurred in 56.7% of patients with positive cTnI and in 28.8% of patients with negative cTnI (p < 0.001). Blood urea nitrogen (BUN) (OR 1.048; 1.001–1.096), alanine transaminase (ALT) (OR 1.007; 1.001–1.014), and neutrophil-lymphocyte ratio (NLR) (OR 0.829; 0.698–0.984) were independent predictors of elevated cTnI. Elevated cTnI increased the risk of MACPE 2.72 times (p < 0.001).


cTnI was an independent predictor of short-term outcome following an episode of PTE. BUN and ALT were directly and NLR was inversely associated with the leakage of cTnI and therefore, they could potentially serve as useful markers of risk assessment after PTE.

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