{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T01:18:16Z","timestamp":1776215896908,"version":"3.50.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T00:00:00Z","timestamp":1556668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Myocardial injury, as reflected by elevated cardiac troponin levels in plasma, is common in patients with community-acquired pneumonia (CAP), but its temporal dynamics and etiology remain unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Our aim was to determine the incidence of troponin release in patients with CAP and identify risk factors that may point to underlying etiologic mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included consecutive patients admitted with severe CAP to two intensive care units in the Netherlands between 2011 and 2015. High-sensitivity cardiac troponin I was measured daily during the first week. We used multivariable linear regression to identify variables associated with troponin release on admission, and we used mixed-effects regression to model the daily rise and fall of troponin levels over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 200 eligible patients, 179 were included, yielding 792 observation days. A total of 152 (85%) patients developed raised troponin levels greater than 26 ng\/L. Baseline factors independently associated with troponin release included coronary artery disease (176% increase; 95% confidence interval [CI], 11\u2013589), smoking (248% increase; 95% CI, 33\u2013809), and higher Acute Physiology and Chronic Health Evaluation IV score (2% increase; 95% CI, 0.8\u20133.3), whereas Staphylococcus aureus as a causative pathogen was protective (70% reduction; 95% CI, 18\u201389). Time-dependent risk factors independently associated with daily increase in troponin concentrations included reduced platelet count (2.3% increase; 95% CI, 0.6\u20134), tachycardia (1.5% increase; 95% CI, 0.1\u20132.9), hypotension (6.2% increase; 95% CI, 2.1\u201310.6), dobutamine use (44% increase; 95% CI, 12\u201385), prothrombin time (8.2% increase; 95% CI, 0.2\u201316.9), white cell count (1.7% increase; 95% CI, 0\u20133.5), and fever (22.7% increase; 95% CI, 0.1\u201349.6).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cardiac injury develops in a majority of patients with severe CAP. Myocardial oxygen supply\u2013demand mismatch and activated inflammation\/coagulation are associated with this injury.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT01905033).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.201804-286oc","type":"journal-article","created":{"date-parts":[[2018,12,6]],"date-time":"2018-12-06T18:23:24Z","timestamp":1544120604000},"page":"606-612","source":"Crossref","is-referenced-by-count":41,"title":["Myocardial Injury in Critically Ill Patients with Community-acquired Pneumonia. A Cohort Study"],"prefix":"10.1093","volume":"16","author":[{"given":"Jos F.","family":"Frencken","sequence":"first","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care"},{"name":"Department of Intensive Care Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lottie","family":"van Baal","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teus H.","family":"Kappen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk W.","family":"Donker","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janneke","family":"Horn","sequence":"additional","affiliation":[{"name":"Department of Intensive Care and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"van der Poll","sequence":"additional","affiliation":[{"name":"Center for Experimental and Molecular Medicine, and"},{"name":"Division of Infectious Diseases, Academic Medical Center, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilton A.","family":"van Klei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc J. M.","family":"Bonten","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care"},{"name":"Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olaf L.","family":"Cremer","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,5,1]]},"reference":[{"key":"2026012203375591200_bib1","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/S0140-6736(12)61266-5","article-title":"Acute pneumonia and the cardiovascular system","volume":"381","author":"Corrales-Medina","year":"2013","journal-title":"Lancet"},{"key":"2026012203375591200_bib2","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1086\/589246","article-title":"Acute myocardial infarction in hospitalized patients with 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