Multimarker cardiocirculatory patterns at ICU admission and mortality in non- cardiac critically ill patients: a retrospective study

Background: Elevated cardiac biomarkers are frequently observed in critically ill patients, even in the absence of primary cardiac disease. Although N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are each associated with adverse outcomes, the clinical relevance of their combined assessment in non-cardiac ICU populations remains uncertain. We investigated whether the joint distribution of NT-proBNP and hs-cTnT at ICU admission delineates distinct cardiocirculatory patterns associated with short-term mortality. In a single-center retrospective cohort of 827 consecutive non-cardiac ICU patients, biomarkers were dichotomized at cohort-specific medians, and patients were classified into four cardiocirculatory patterns. The primary outcome was 30-day all-cause mortality. Results: The identified cardiocirculatory patterns differed significantly with respect to baseline characteristics and markers of hemodynamic instability, metabolic stress, systemic inflammation, and organ dysfunction. Thirty-day survival varied markedly across patterns (log-rank p < 0.001). After adjustment for disease severity using the Sequential Organ Failure Assessment (SOFA) score, only the combined high NT-proBNP/high hs-cTnT pattern was independently associated with increased 30-day mortality (adjusted hazard ratio 1.51; 95% CI 1.16–1.97; p = 0.002). Isolated elevation of either NT-proBNP or hs-cTnT alone was not independently associated with mortality. Conclusions: In non-cardiac critically ill patients, the combined assessment of NT-proBNP and hs-cTnT at ICU admission identifies distinct cardiocirculatory patterns with divergent clinical profiles and prognoses. This multimarker phenotyping approach provides prognostic information beyond isolated biomarker interpretation and may enhance early risk stratification in the ICU setting.