Troponin Elevation in Subarachnoid Hemorrhage Does not Impact In-hospital Mortality

Gupte, Manisha; John, Sayona; Prabhakaran, Shyam; Lee, Vivien

doi:10.1007/s12028-012-9813-y

Cited by 23 publications

(22 citation statements)

References 22 publications

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“…This observation concurs with some of the previous studies [1, 11]. Meanwhile, studies reporting elevated troponin as a prognostic risk factor for mortality were not adjusted for other cardiovascular abnormalities [10, 20].…”

Section: Discussionsupporting

confidence: 91%

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Cardiovascular Abnormalities and in-Hospital All-Cause Mortality in Patients with Spontaneous Sub-Arachnoid Hemorrhage: An Observational Study

2016

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IntroductionPatients with spontaneous sub-arachnoid hemorrhage (SAH) might develop various cardiac abnormalities, however; the prognostic implications of these cardiac abnormalities are not well known. This study aimed to detect the cardiac abnormality that correlates best with in-hospital all-cause mortality in patients with SAH.MethodsIn this retrospective study, all patients admitted to our institution with a primary diagnosis of SAH, and underwent a transthoracic echocardiogram (TTE) from July 2011 until May 2014, were enrolled. Data gathered included patients’ demographics, Hunt and Hess clinical grading, computed tomography SAH Fisher grading, troponin T level, electrocardiographic (ECG) changes, TTE, and in-hospital all-cause mortality. Multivariate logistic regression of the cardiac abnormalities and in-hospital all-cause mortality was performed.ResultsA total of 247 patients were included in our analysis. In-hospital all-cause mortality was 15.6% (38 patients). The presence of elevated troponin T levels, resting segmental wall motion abnormalities, reduced ejection fraction (<35%), and prolonged corrected QT interval (QTc) on ECG were associated with increased in-hospital all-cause mortality on univariate analysis. On multivariable regression, QTc prolongation was the only independent predictor for in-hospital all-cause mortality (p = 0.04).ConclusionsProlonged QTc interval on ECG was independently associated with in-hospital all-cause mortality in patients presenting with spontaneous SAH. Whether this is a causative association or a marker of underlying severe clinical presentation of SAH remains unknown.

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Section: Discussionsupporting

confidence: 91%

“…Sub-arachnoid hemorrhage (SAH) is associated with a high mortality, particularly within the first 48 h of presentation [1, 2]. Although cardiac injury in SAH has been previously described [3–5], the prognostic implications of cardiac injury and its relationship with short-term mortality remain controversial.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Abnormalities and in-Hospital All-Cause Mortality in Patients with Spontaneous Sub-Arachnoid Hemorrhage: An Observational Study

2016

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“…After title screening and detailed abstract evaluation, 46 studies were selected. After detailed evaluation of the full 46 article, 12 studies [8][9][10][11][12]18,[24][25][26][27][28][29] were selected for inclusion in this review. No overlap was found among these 12 studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…It was measured repeatedly for consecutive days, [8][9][10][11][12]27 on the day of admission only, 18,24,26,28 or both. 25,29 …”

Section: Study Characteristicsmentioning

confidence: 99%

Cardiac Troponin Elevation and Outcome after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Zhang

Wang

2015

Journal of Stroke and Cerebrovascular Diseases

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“…Several complications such as intraventricular hemorrhage (IVH), acute hydrocephalus, early hematoma expansion, and perihemorrhagic edema may occur during hospital stay and have been previously verified to independently impact outcome [2][3][4][5][6]. In addition, recent studies reported a high rate of cardiac complications presumably linked to a further increase in mortality of patients with intracranial hemorrhage [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

et al. 2018

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Background: Troponin I is a widely used and reliable marker of myocardial damage and its levels are routinely measured in acute stroke care. So far, the influence of troponin I elevations during hospital stay on functional outcome in patients with atraumatic intracerebral hemorrhage (ICH) is unknown. Methods: Observational single-center study including conservatively treated ICH patients over a 9-year period. Patients were categorized according to peak troponin I level during hospital stay (≤0.040, 0.041–0.500, > 0.500 ng/mL) and compared regarding baseline and hematoma characteristics. Multivariable analyses were performed to investigate independent associations of troponin levels during hospital stay with functional outcome – assessed using the modified Rankin Scale (mRS; favorable 0–3/unfavorable 4–6) – and mortality after 3 and 12 months. To account for possible confounding propensity score (PS)-matching (1: 1; caliper 0.1) was performed accounting for imbalances in baseline characteristics to investigate the impact of troponin I values on outcome. Results: Troponin elevations (> 0.040 ng/mL) during hospital stay were observed in 308 out of 745 (41.3%) patients and associated with poorer status on admission (Glasgow Coma Scale/National Institute of Health Stroke Scale). Multivariable analysis revealed troponin I levels during hospital stay to be independently associated with unfavorable outcome after 12 months (risk ratio [95% CI]: 1.030 [1.009–1.051] per increment of 1.0 ng/mL; p = 0.005), but not with mortality. After PS-matching, patients with troponin I elevation (≥0.040 ng/mL) versus those without had a significant higher rate of unfavorable outcome after 3 and 12 months (mRS 4–6 at 3 months: < 0.04 ng/mL: 159/265 [60.0%] versus ≥0.04 ng/mL: 199/266 [74.8%]; p < 0.001; at 12 months: < 0.04 ng/mL: 141/248 [56.9%] versus ≥0.04 ng/mL: 179/251 [71.3%]; p = 0.001). Conclusions: Troponin I elevations during hospital stay occur frequently in ICH patients and are independently associated with functional outcome after 3 and 12 months but not with mortality.

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Troponin Elevation in Subarachnoid Hemorrhage Does not Impact In-hospital Mortality

Abstract: Troponin I elevation after SAH is not an independent predictor of in-hospital mortality.

Cited by 23 publications

References 22 publications

Cardiovascular Abnormalities and in-Hospital All-Cause Mortality in Patients with Spontaneous Sub-Arachnoid Hemorrhage: An Observational Study

Cardiovascular Abnormalities and in-Hospital All-Cause Mortality in Patients with Spontaneous Sub-Arachnoid Hemorrhage: An Observational Study

Cardiac Troponin Elevation and Outcome after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

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