Prognostic value of high-sensitivity troponin T in aneurysmal subarachnoid hemorrhage: a prospective observational study

Abstract

Objective: To evaluate the prognostic value of high-sensitivity troponin (hsT) in severe aneurysmal subarachnoid hemorrhage (aSAH). Methods: This prospective non-interventional study was performed at a surgical intensive care unit (ICU) from 2012 to 2015. Consecutive patients who had severe aSAH were included. A modified Rankin Scale score ≥ 4 or death within 3 months defined a poor outcome. hsT levels were measured at ICU admission and 72 hours following symptom onset. Results: A total of 137 patients were analyzed. The median hsT level was 29 ng/L (range: 7-4485). The best threshold level of hsT for predicting a poor outcome was 22 ng/L. At this threshold, the sensitivity was 71% (95% confidence interval [CI]: 58%-81%) and the specificity was 58% (95%CI: 46%-70%). The area under the ROC curve was 0.61 (95%CI: 0.52-0.71). Based on a multivariate analysis, the independent factors for a poor neurological prognosis were a World Federation of Neurologic Surgeons (WFNS) score ≥ 4 (odds ratio [OR]: 2.61; 95%CI: 1.04-6.56) and an hsT level > 22 ng/L (OR: 2.80; 95%CI: 1.18-6.64). Conclusion: In patients with severe aSAH, with regard for the severity of disease (assessed by the WFNS score), an hsT level > 22 ng/L at ICU admission was associated with poor outcomes.

Association of Troponin T levels and functional outcome 3 months after subarachnoid hemorrhage

“…Moreover, in a multicenter cohort study, regional wall motion abnormalities (RWMA) after SAH were found to be an independent predictor of outcome after SAH while troponin T elevation was not 7 . Our results confirm the latter observation, but there are also trials suggesting a causal relationship between the early biomarker release such as troponin T and outcome after SAH 8 , 25 . Further research in a preferably multicenter setting is warranted to clarify the impact of the elevated biomarker levels on the outcome after SAH.…”

“…While there is widely agreement about the mechanism behind these findings involving abnormal sympathetic innervation with an excessive norepinephrine release, their impact on short and long term outcome remains controversial 24 . There are only very few studies who have prospectively evaluated the association between cardiac troponins and outcome after SAH, and only two of them used a high sensitive troponin essay similar to the one in the present study 8 , 25 . To the best of our knowledge, the present study is the first one prospectively conducting serial hs troponin T measurements for 14 days after admission.…”

Prognostic Value of Elevated Cardiac Troponin I After Aneurysmal Subarachnoid Hemorrhage

“…The cTnI elevation observed in this population is in keeping with the data produced by van der Bilt et al (6) and Zhang et al (7). Numerous studies have reported the reasonable predictive potential of admission elevated-troponin in aSAH patients, but lots of studies focused on the short-term neurological outcomes (7,9,20,21), although several teams started to foresee the sensitivity and specificity of cTnI on long-term outcomes (7,10,16). However, none of the studies were performed for longer than 1 year.…”

Elevated troponin levels as a predictor of mortality in patients with acute stroke: a systematic review and meta-analysis

“…Finally, 53 studies (23-73) were included that examined the role of elevated troponin for predicting mortality in acute stroke. Among these studies, 37 studies focused on AIS patients (23-59), 11 on SAH patients (28,53,(60)(61)(62)(63)(64)(65)(66)(67)(68), and 7 on ICH patients (28,53,(69)(70)(71)(72)(73). The AIS studies involved 3,606 patients with elevated troponin and 14,099 patients with normal troponin, the SAH studies involved 450 patients with elevated troponin and 980 patients with normal troponin, and the ICH studies involved 1,041 patients with elevated troponin and 1,259 patients with normal troponin.…”