Blood Culture and Troponin Testing in Suspected Bacteraemic Admissions – Example of Risk Stratification Based on Clinical Testing

Blood Culture and Troponin Testing in Suspected Bacteraemic Admissions – Example of Risk Stratification Based on Clinical Testing

Aim: To investigate the clinical predictive value of troponin (hscTnT) and blood culture testing.
Methods: We examined all medical admissions from 2011-2020. Prediction of 30-day in-hospital mortality, dependent on blood culture and hscTnT requests/results, was evaluated using multiple variable logistic regression. Length of stay was related to utilization of procedures/services with truncated Poisson regression.
Results: There were 77,566 admissions in 42,325 patients. With both blood cultures and hscTnT requested, 30-day in-hospital mortality increased to 20.9% (95%CI: 19.7, 22.1) vs 8.9% (95%CI: 8.5, 9.4) for blood cultures alone and 2.3% (95%CI: 2.2, 2.4) with neither. Blood culture 3.93 (95%CI: 3.50, 4.42) or hsTnT requests 4.58 (95%CI: 4.10, 5.14) were prognostic.
Conclusion: Blood culture and hscTnT requests and results predict worse outcomes.

References

  1. Rooney T, Bennett K, Silke B. Reduced mortality and length of stay in a teaching hospital after establishment of an acute medical admission unit (AMAU): A 5-year prospective study. European Journal of Internal Medicine. 2008;19(1):E3.
  2. Rooney T, Moloney ED, Bennett K, O’Riordan D, Silke B. Impact of an acute medical admission unit on hospital mortality: a 5-year prospective study. QJM. 2008;101(6):457-65.
  3. Moloney ED, Smith D, Bennett K, O’Riordan D, Silke B. Impact of an acute medical admission unit on length of hospital stay, and emergency department ‘wait times’. QJM. 2005;98(4):283-9.
  4. Conway R, O’Riordan D, Silke B. Long-term outcome of an AMAU--a decade’s experience. Quarterly Journal of Medicine. 2014;107(1):43-9.
  5. Scott I, Vaughan L, D. B. Effectiveness of acute medical units in hospitals: a systematic review. Int J Qual Health Care. 2009;21(6):397-407.
  6. Byrne D, Silke B. Acute medical units: review of evidence. Eur J Intern Med. 2011;22(4):344-7.
  7. Bell D, Lambourne A, Percival F, Laverty AA, Ward DK. Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis. PloS one. 2013;8(4):e61476.
  8. Thomas S, Burke S, Barry S. The Irish health-care system and austerity: sharing the pain. Lancet. 2014;383:1545-6.
  9. Prytherch DR, Sirl JS, Schmidt P, Featherstone PI, Weaver PC, Smith GB. The use of routine laboratory data to predict in-hospital death in medical admissions. Resuscitation. 2005;66(2):203-7.
  10. Froom P, Shimoni Z. Prediction of hospital mortality rates by admission laboratory tests. Clin Chem. 2006;52(2):325-8.
  11. Hucker TR, Mitchell GP, Blake LD, Cheek E, Bewick V, Grocutt M, et al. Identifying the sick: can biochemical measurements be used to aid decision making on presentation to the accident and emergency department. Br J Anaesth. 2005;94(6):735-41.
  12. Silke B, Kellett J, Rooney T, Bennett K, O’Riordan D. An improved medical admissions risk system using multivariable fractional polynomial logistic regression modelling. Quarterly Journal of Medicine. 2010;103(1):23-32.
  13. Froom P, Shimoni Z, Benbassat J, Silke B. A simple index predicting mortality in acutely hospitalized patients. (1460-2393 (Electronic)).
  14. Peacock WF, De Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, et al. Cardiac troponin and outcome in acute heart failure. N Engl J Med. 2008;358(20):2117-26.
  15. Aimo A, Januzzi James L, Vergaro G, Ripoli A, Latini R, Masson S, et al. Prognostic Value of High-Sensitivity Troponin T in Chronic Heart Failure. Circulation. 2018;137(3):286-97.
  16. Apple Fred S, Murakami MaryAnn M, Pearce Lesly A, Herzog Charles A. Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease. Circulation. 2002;106(23):2941-5.
  17. Botto F, Alonso-Coello P, Chan MT, Villar JC, Xavier D, Srinathan S, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014;120(3):564-78.
  18. Vasile VC, Chai HS, Abdeldayem D, Afessa B, Jaffe AS. Elevated cardiac troponin T levels in critically ill patients with sepsis. Am J Med. 2013;126(12):1114-21.
  19. Conway R, O’Connell B, Byrne D, O’Riordan D, Silke B. Prognostic Value Of Blood Cultures as an Illness Severity Marker In Emergency Medical Admissions. Acute Med. 2020;19(2):83-9.
  20. Conway R, Byrne D, Cournane S, O’Riordan D, Coveney S, Silke B. Troponin status predicts 30-day in-hospital mortality. Vessel Plus. 2020;4:10/1.
  21. Coary R, Byrne D, O’Riordan D, Conway R, Cournane S, Silke B. Does admission via an Acute Medical Unit influence hospital mortality? 12 years’ experience in a large Dublin Hospital. Acute Med. 2014;13(4):152-8.
  22. Conway R, Byrne D, O’Riordan D, Silke B. Outcomes in acute medicine - Evidence from extended observations on readmissions, hospital length of stay and mortality outcomes. Eur J Intern Med. 2019;66:69-74.
  23. Conway R, Byrne D, Cournane S, O’Riordan D, Silke B. Fifteen-year outcomes of an acute medical admission unit. Ir J Med Sci. 2018;187(4):1097-105.
  24. O’Loughlin R, Allwright S, Barry J, Kelly A, Teljeur C. Using HIPE data as a research and planning tool: limitations and opportunities. Ir J Med Sci. 2005;174(2):40-5; discussion 52-7.
  25. O’Callaghan A, Colgan MP, McGuigan C, Smyth F, Haider N, O’Neill S, et al. A critical evaluation of HIPE data. Ir Med J. 2012;105(1):21-3.
  26. Courtney D, Conway R, Kavanagh J, O’Riordan D, Silke B. High-sensitivity troponin as an outcome predictor in acute medical admissions. Postgrad Med J. 2014:1-7.
  27. Chotirmall SH, Callaly E, Lyons J, O’Connell B, Kelleher M, Byrne D, et al. Blood cultures in emergency medical admissions: a key patient cohort. Eur J Emerg Med. 2014.
  28. Chotirmall SH, Picardo S, Lyons J, D’Alton M, O’Riordan D, Silke B. Disabling disease codes predict worse outcomes for acute medical admissions. Intern Med J. 2014;44(6):546-53.
  29. Conway R, Byrne D, O’Riordan D, Silke B. Comparative influence of Acute Illness Severity and Comorbidity on mortality. European Journal of Internal Medicine. 2020;72:42-6.
  30. Kopelman PG, Sanderson AJ. Application of database systems in diabetes care. Medical informatics = Medecine et informatique. 1996;21(4):259-71.
  31. Courtney D, Conway R, Kavanagh J, O’Riordan D, Silke B. High-sensitivity troponin as an outcome predictor in acute medical admissions. Postgraduate medical journal. 2014;90(1064):311-6.
  32. Chin JL, O’Dowd S, Adnan WA, Bennett K, O’Riordan D, Mellotte GJ, et al. Using the MDRD value as an outcome predictor in emergency medical admissions. Nephrol Dial Transplant. 2011;26(10):3155-9.
  33. Conway R, Byrne D, O’Riordan D, Silke B. Emergency readmissions are substantially determined by acute illness severity and chronic debilitating illness: A single centre cohort study. Eur J Intern Med. 2015;26(1):12-7.
  34. Conway R, Galvin S, Coveney S, O’Riordan D, Silke B. Deprivation as an outcome determinant in emergency medical admissions. QJM. 2013;106(3):245-51.
  35. Conway R, Byrne D, O’Riordan D, Silke B. Comparative influence of Acute Illness Severity and comorbidity on mortality. Eur J Intern Med. 2020;72:42-6.
  36. Cameron A, Trivedi P. Microeconometrics Using Stata. College Station, TX: Stata Press; 2009.
  37. John J, Woodward DB, Wang Y, Yan SB, Fisher D, Kinasewitz GT, et al. Troponin-I as a prognosticator of mortality in severe sepsis patients. J Crit Care. 2010;25(2):270-5.
  38. Zochios V, Valchanov K. Raised cardiac troponin in intensive care patients with sepsis, in the absence of angiographically documented coronary artery disease: A systematic review. J Intensive Care Soc. 2015;16(1):52-7.
  39. Cournane S, Byrne D, O’Riordan D, Sheehy N, Silke B. Pattern of Investigation Reflects Risk Profile in Emergency Medical Admissions. Journal of clinical medicine. 2015;4(5):1113-25.
  40. Froom P, Shimoni Z. Decreasing the Overuse of Troponin Testing– An Interventional Study in a Regional Hospital. The American Journal of Medicine. 2020.
  41. Wilson G, Barkley K, Slicker K, Kowal R, Pope B, Michel J. Overuse of Troponin? A Comprehensive Evaluation of Testing in a Large Hospital System. J Hosp Med. 2017;12(5):329-31.
  42. Conway R, Murray FE. Assessment of service delays and impact on bed utilisation in a major teaching hospital. Ir J Med Sci. 2011;180(2):533-5.

Request Permissions

To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:

Get Permission

Blood Culture and Troponin Testing in Suspected Bacteraemic Admissions – Example of Risk Stratification Based on Clinical Testing

23rd February 2023
PMID: 36809448
Authors Affiliations
Richard Conway MED Directorate, St James’s Hospital, Dublin 8, Ireland.
Declan Byrne MD, Department of Internal Medicine, St James’s Hospital, Dublin 8, Ireland
Deirdre O’Riordan MD, Department of Internal Medicine, St James’s Hospital, Dublin 8, Ireland
Bernard Silke MED Directorate, St James’s Hospital, Dublin 8, Ireland.

Blood Culture and Troponin Testing in Suspected Bacteraemic Admissions – Example of Risk Stratification Based on Clinical Testing

Cite this article as:

Conway R, Byrne D, O'Riordan D, Silke B. Blood Culture and Troponin Testing in Suspected Bacteraemic Admissions - Example of Risk Stratification Based on Clinical Testing. Acute Med. 2022;21(4):176-181. doi: 10.52964/AMJA.0921. PMID: 36809448.

Blood Culture and Troponin Testing in Suspected Bacteraemic Admissions – Example of Risk Stratification Based on Clinical Testing

Share this article

Click the icon of the social media platform on which you would like to share this article.


Shopping Basket
Scroll to Top