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

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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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Authors and Affiliations

  1. Division of Cardiology, Harper University Hospital, Wayne State University, 1 Webber South, 3990, John R. Street, Detroit, MI, 48201, USA

    Preeti Ramappa & Deepak Thatai

  2. Division of Neurology, Wayne State University, Detroit, MI, USA

    William Coplin & Benjamin Atkinson

  3. Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA

    Steven Gellman

  4. Division of Neurology, The Johns Hopkins Hospital, Baltimore, USA

    J. Ricardo Carhuapoma

  5. Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA

    Ruth Quah

  6. Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    James D. Marsh

Authors
  1. Preeti Ramappa
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  2. Deepak Thatai
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  3. William Coplin
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  4. Steven Gellman
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  5. J. Ricardo Carhuapoma
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  6. Ruth Quah
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  7. Benjamin Atkinson
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  8. James D. Marsh
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Correspondence to Preeti Ramappa.

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Ramappa, P., Thatai, D., Coplin, W. et al. Cardiac Troponin-I: A Predictor of Prognosis in Subarachnoid Hemorrhage. Neurocrit Care 8, 398–403 (2008). https://doi.org/10.1007/s12028-007-9038-7

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  • DOI: https://doi.org/10.1007/s12028-007-9038-7

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