Cardiac troponin and cerebral herniation in acute intracerebral hemorrhage

Xu, Mangmang; Lin, Jing; Wang, Deren; Liu, Ming; Zeng, Hao; Lei, Chunyan

doi:10.1002/brb3.697

Cited by 11 publications

(11 citation statements)

References 29 publications

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“…The association between increased serum cardiac troponin level and poor outcome of these diseases has also been con rmed in previous studies [31][32][33]. In addition, the elevation of cardiac troponin was also discovered in non-traumatic brain injury patients including ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage [34][35][36][37]. And the degree of increased cardiac troponin was positively correlated with occurrence of cardiovascular dysfunction, brain injury severity and poor outcome of these brain injured patients [11,[38][39][40][41][42][43].…”

Section: Discussionsupporting

confidence: 70%

The Prognostic Value of Cardiac Troponin T in Different Age Groups of Traumatic Brain Injury Patients

Wang

Kang

2020

Preprint

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Background The cardiac dysfunction has been confirmed as a common non-neurological complication and associated with increased mortality in traumatic brain injury (TBI) patients. As a biological marker of cardiac injury, the cardiac troponin T (TnT) has been verified correlated with outcome of some non-traumatic brain injury patients. However, the prognostic value of TnT in TBI patients has not been clearly illustrated. We designed this study to explore the association between TnT and outcome of TBI patients in different age subgroups. Methods Patients diagnosed with TBI in a prospective critical care database were eligible for this study. Univariate logistic regression analysis was firstly performed to explore the relationship between included variables and mortality. Then, the real effect of TnT on outcome of different age subgroups was analyzed by multivariate logistic regression analysis adjusting the confounding effects of other significant risk factors. Finally, we draw receiver operating characteristic (ROC) curves to evaluate the prognostic value of TnT in different age groups of TBI patients. Results 520 patients were included in this study with mortality rate of 20.2%. There were 112 (21.5%) non-elderly patients (age < 65) and 408 (78.5%) elderly patients (age ≥ 65). Non-survivors had higher percentage of previous acute myocardial infarction (p = 0.019) and pupil no-reaction (p = 0.028; p = 0.011) than survivors. Survivors had higher GCS (p < 0.001) and lower TnT than non-survivors (p < 0.001). TnT was significantly associated with mortality in non-elderly patients (p = 0.031) but not in overall patients (p = 0.143) and elderly patients (p = 0.456) in multivariate logistic regression analysis. The AUC (area under the ROC curve) value of TnT in overall, non-elderly and elderly patients was 0.644, 0.693 and 0.632, respectively. Combining TnT with GCS increased the sensitivity of predicting mortality of both non-elderly and elderly TBI patients. Conclusion The prognostic value of TnT differed between elderly and non-elderly TBI patients. Level of TnT was associated with mortality of non-elderly TBI patients but not elderly patients. Combining the TnT with GCS could increase the sensitivity of prognosis evaluation.

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Section: Discussionsupporting

confidence: 70%

The Prognostic Value of Cardiac Troponin T in Different Age Groups of Traumatic Brain Injury Patients

Wang

Kang

2020

Preprint

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“…Further, we did not specifically note the timing and amount of administered catecholamines and the occurrence and duration of cardiac arrhythmias. In addition, despite adjustments residual confounding, notably response bias as a result of our outcome assessment, cannot be fully excluded and complications reported to be potentially associated with troponin elevations, such as cerebral herniation [38], were not specifically documented. Due to the exclusion of secondary causes of ICH, such as hemorrhagic transformation or ruptured arteriovenous malformation, our findings cannot be applied to all subtypes of ICHpatients.…”

Section: Discussionmentioning

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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“…The previous study demonstrated that elevated troponin levels were associated with higher mortality following ICH . Subsequently, the utility of elevated troponin levels for prediction of mortality was confirmed in surgical ICH patients, but was not found to be consistently associated with in‐hospital mortality in Chinese ICH patients . Small sample sizes (less than 240 stroke patients) and ethnic variability probably contribute to the negative results and discrepancies.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of elevated cardiac troponin I in patients with intracerebral hemorrhage

Yang

Liu

Wang

et al. 2019

Clinical Cardiology

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Background Although cardiac troponin has been well established as diagnostic and prognostic makers for acute coronary heart disease, the prognostic value of elevated cardiac troponin in patients with intracerebral hemorrhage (ICH) was inconsistent and not systematically evaluated. Hypothesis We proposed the hypothesis that the practical utility of cardiac troponin levels for prediction of mortality and poor outcome in ICH patients. Methods A total of 1004 patients with ICH were retrospectively reviewed and qualified for further analysis from June 2012 to December 2015. The patients were divided into different groups based on measurements of cardiac troponin I (cTnI) at the time of admission and the following day. Multivariate Cox proportional hazards analysis were performed to determine the independent prognostic value of the cTnI for patients in‐hospital mortality and poor outcomes, the receiver operator characteristic (ROC) analysis was performed to assess the predictive value of cTnI, ICH score, and combination of them. Results Serum cTnI level was an independent predictor in‐hospital mortality (positive vs negative, HR (hazard ratios) = 3.44, 95% CI (confidence interval) 1.66‐7.13, P < .001) and poor outcomes in patients with ICH (positive vs negative, HR = 6.69, 95% CI 4.25‐10.52, P < .001). Addition of cTnI to ICH score significantly improved the prognostic discrimination for both in‐hospital mortality and poor outcomes. Conclusion Serum cTnI levels may be valuable as predictor for in hospital mortality and poor outcomes and may be useful in the risk stratification of ICH during hospitalization.

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Cardiac troponin and cerebral herniation in acute intracerebral hemorrhage

Cited by 11 publications

References 29 publications

The Prognostic Value of Cardiac Troponin T in Different Age Groups of Traumatic Brain Injury Patients

The Prognostic Value of Cardiac Troponin T in Different Age Groups of Traumatic Brain Injury Patients

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

Prognostic value of elevated cardiac troponin I in patients with intracerebral hemorrhage

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