Parekh NK et al. (2007) Elevated troponin I levels in acute liver failure: is myocardial injury an integral part of acute liver failure? Hepatology 45: 1489–1495

Elevated troponin I levels, indicative of cardiac muscle damage, are found in some patients with sepsis or acute stroke. Heart problems sometimes occur in patients with acute liver failure (ALF), but whether cardiac damage is a common occurrence in these patients is unknown. To shed some light on the matter, Parekh et al. investigated the prevalence of elevated troponin I levels in patients with ALF for the Acute Liver Failure Study Group.

The study population comprised 187 patients from the US ALF registry. Serum troponin I levels indicative of myocardial injury (defined as a troponin I level >0.1 ng/ml) were found in 138 participants (74%). Increasing troponin I levels correlated with advanced hepatic coma, death, and death after transplant. For those with elevated troponin I levels, the odds ratios for advanced coma and death were 3.88 and 4.69, respectively. Three weeks after enrollment, 34.4% of those with elevated troponin I levels had died, compared with 10.2% of those with normal levels. Troponin I levels also correlated positively with APACHE II scores, and negatively with glomerular filtration rate.

The author conclude that, although the mechanism of cardiac injury in patients with ALF remains unknown, subclinical cardiac damage could have a considerable negative impact on the outcome for patients with ALF. Troponin I might be useful both as a marker of cardiac injury and as a predictor of outcome.