Cardiac Troponin-I: A Predictor of Prognosis in Subarachnoid Hemorrhage |
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Authors: | Preeti Ramappa Deepak Thatai William Coplin Steven Gellman J Ricardo Carhuapoma Ruth Quah Benjamin Atkinson James D Marsh |
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Institution: | Division of Cardiology, Harper University Hospital, Wayne State University, 1 Webber South, 3990, John R. Street, Detroit, MI 48201, USA. pramappa@med.wayne.edu |
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Abstract: | 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 <12 (p = 0.02) were independent predictors of death at discharge.
Conclusion Patients with subarachnoid hemorrhage and elevated
cTnI are found to have worse neurological status at admission. These patients have a worse neurological outcome and in-hospital
mortality. |
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Keywords: | Troponin Subarachnoid hemorrhage Mortality Neurological outcome |
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