{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:28:10Z","timestamp":1790890090153,"version":"4.1.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The clinical implications of high-sensitivity cardiac troponin T (hs-cTnT) measurements in patients with acute kidney injury (AKI) in the emergency department (ED) are largely unknown.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To investigate associations between serum creatinine (SCr) concentrations and hs-cTnT kinetics, as well as the clinical accuracy of hs-cTnT for myocardial infarction (MI) in patients with AKI.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study included 15\u202f111 patient visits to 7 EDs in Sweden from December 9, 2010, to August 31, 2017, by patients 18 years or older fulfilling AKI criteria with 2 or more SCr measurements and 1 or more hs-cTnT measurement. Statistical analysis was performed from October 2, 2022, to September 28, 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Dynamic change in SCr during the ED visits.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Linear mixed-effects models were used to estimate the log-linear regression of kinetic change in hs-cTnT. Logistic regression models were applied to calculate odds ratios (ORs) for change in hs-cTnT indicating acute myocardial injury (\u0394hs-cTnT &amp;gt;20% and elevated hs-cTnT &amp;gt;14 ng\/L) in association with change in SCr, and to assess the diagnostic performance of hs-cTnT for MI in patients with chest pain.<\/jats:p><\/jats:sec>Results<\/jats:title>There was a total of 15\u202f211 visits by 13\u202f638 patients (median age, 74 years [IQR, 64-83 years]; 8709 men [57%]), of whom 1174 (8%) had an MI. Overall, 11\u202f353 of patients at 14\u202f037 visits without an MI diagnosis (81%) had myocardial injury, and 4396 patients at 14\u202f037 visits (31%) had acute myocardial injury. The change in hs-cTnT among patients without MI was 1.8-fold higher in the highest vs the lowest change in SCr quartile (64.7% [95% CI, 58.4%-71.5%] vs 36.3% [95% CI, 32.4%-40.7%]; exponentiated \u03b2 coefficient, 1.78 [95% CI, 1.62-1.96]). Patients in the former group were twice as likely to have acute myocardial injury (39% [1378 of 3516 visits] vs 23% [817 of 3507 visits]; adjusted OR, 2.32 [95% CI, 2.08-2.59]). Using a 0 hours hs-cTnT cutoff value of 52 ng\/L or higher assigned 627 of 2388 patients (26%) with chest pain to a high-risk group in whom the specificity and positive predictive value for MI was low (78.5% [95% CI, 76.7%-80.2&amp;amp;] and 27.6% [95% CI, 24.1%-31.3%], respectively).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cohort study of patients in the ED suggests that dynamic change in SCr among patients with AKI was associated with hs-cTnT concentrations indicative of acute myocardial injury. These observations were accompanied by poor performance of recommended hs-cTnT\u2013based algorithms for MI risk stratification.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.19602","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T15:31:29Z","timestamp":1725031889000},"page":"e2419602","source":"Crossref","is-referenced-by-count":14,"title":["Acute Kidney Injury and High-Sensitivity Cardiac Troponin T Levels in the Emergency Department"],"prefix":"10.1001","volume":"7","author":[{"given":"Love","family":"Cyon","sequence":"first","affiliation":[{"name":"Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Solna, Stockholm, Sweden"},{"name":"Department of Emergency and Reparative Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Kadesj\u00f6","sequence":"additional","affiliation":[{"name":"Department of 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