Cardiac troponin I as predictor for cardiac and other mortality in the German randomized lung cancer screening trial (LUSI)

• Published in: Scientific reports Vol. 14; no. 1; pp. 7197 - 9
• Main Authors: Cortés-Ibáñez, Francisco O., Johnson, Theron, Mascalchi, Mario, Katzke, Verena, Delorme, Stefan, Kaaks, Rudolf
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 26.03.2024; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4028; 692/4028/67/2324; 692/53; 692/699/75/230; Biomarkers; Blood; Blood & organ donations; Blood donors; Cancer screening; Death; Early Detection of Cancer; Heart; Humanities and Social Sciences; Humans; Lung cancer; Lung cancer screening; Lung Neoplasms; Medical screening; Mortality; multidisciplinary; Myocardial infarction; Predictive Value of Tests; Prognosis; Risk assessment; Risk factors; ROC Curve; Science; Science (multidisciplinary); Smoking; Troponin; Troponin I; Myocardial infarction; Biomarkers; Troponin; Lung cancer screening; Mortality; Risk assessment
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-57889-z

Cardiac Troponin I (cTnI) could be used to identify individuals at elevated risk of cardiac death in lung cancer (LC) screening settings. In a population-based, randomized LC screening trial in Germany (“LUSI” study) serum cTnI was measured by high-sensitivity assay in blood samples collected at baseline, and categorized into unquantifiable/low (< 6 ng/L), intermediate (≥ 6–15 ng/L), and elevated (≥ 16 ng/L). Cox proportional-hazard models were used to estimate risk of all-cause and cardiac mortality with cTnI levels. After exclusion criteria, 3653 participants were included for our analyses, of which 82.4% had low, 12.8% intermediate and 4.8% elevated cTnI, respectively. Over a median follow up of 11.87 years a total of 439 deaths occurred, including 67 caused by cardiac events. Within the first 5 years after cTnI measurement, intermediate or elevated cTnI levels showed approximately 1.7 (HR = 1.69 [95% CI 0.57–5.02) and 4.7-fold (HR = 4.66 [1.73–12.50]) increases in risk of cardiac death relative to individuals with unquantifiable/low cTnI, independently of age, sex, smoking and other risk factors. Within this time interval, a risk model based on age, sex, BMI, smoking history and cTnI showed a combined area under the ROC curve (AUC) of 73.6 (58.1–87.3), as compared to 70.4 (53.3–83.5) for a model without cTnI. Over the time interval of > 5–10 years after blood donation, the relative risk associations with cTnI and were weaker. cTnI showed no association with mortality from any other (non-cardiac) cause. Our findings show that cTnI may be of use for identifying individuals at elevated risk specifically of short-term cardiac mortality in the context of LC screening.