Cardiac Troponin-I: A Predictor of Prognosis in Subarachnoid Hemorrhage

• Published in: Neurocritical care 2008-06, Vol.8 (3), p.398-403
• Main Authors: Ramappa, Preeti, Thatai, Deepak, Coplin, William, Gellman, Steven, Carhuapoma, J. Ricardo, Quah, Ruth, Atkinson, Benjamin, Marsh, James D.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomarkers; Biomarkers - blood; Cardiovascular disease; Coronary vessels; Critical Care Medicine; Diabetes; Edema; Electrocardiography; Female; Glasgow Coma Scale; Hemorrhage; Hospital Mortality; Hospitals; Humans; Hydrocephalus; Hypertension; Incidence; Intensive; Internal Medicine; Logistic Models; Male; Medical imaging; Medical Records; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multivariate Analysis; Neurology; Original Article; Patients; Predictive Value of Tests; Prognosis; Stroke; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - metabolism; Subarachnoid Hemorrhage - mortality; Troponin I - blood; Vein & artery diseases
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-007-9038-7

Background Release of cardiac biomarkers is reported in patients with subarachnoid hemorrhage (SAH). Data addressing the impact of cardiac injury on outcome in these patients is sparse. This study was conducted to ascertain the association of elevation of serum cardiac Troponin-I (cTnI) with mortality and neurological outcome in patients with SAH. Methods Medical records of all patients admitted with a diagnosis of SAH and at least one measured cTnI were reviewed. Demographic and clinical variables including admission neurological status were collected. Conservative and non-parametric statistics were used to assess association between cTnI and death or neurological outcome at discharge. Results The study group comprised of 83 patients with a mean age of 59 years. There was a female (60%) and African-American (60%) preponderance. At admission, the median Glasgow Coma Scale (GCS) was 9, and 47% had a severe Hunt–Hess grade (HHG) of ≥4. Elevation of cTnI was found in 31 (37%) patients and was associated with worse baseline Fisher grade ( p =0.01) and neurological status: GCS score ( p =0.006) and HHG ( p =0.007). Patients with abnormal cTnI were more likely to die (55% vs.27%; odds ratio 1.3–8.4, p = 0.01) and had a worse GCS score ( p  = 0.008) and HHG ( p  = 0.004) on discharge. On multivariate analysis, peak cTnI ( p = 0.04) and admission GCS score of