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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2005 Nov;76(11):1565–1569. doi: 10.1136/jnnp.2004.060913

Troponin I in predicting cardiac or pulmonary complications and outcome in subarachnoid haemorrhage

W Schuiling 1, P Dennesen 1, J Tans 1, L Kingma 1, A Algra 1, G Rinkel 1
PMCID: PMC1739406  PMID: 16227553

Abstract

Background: Patients with aneurysmal subarachnoid haemorrhage (SAH) are at risk of cardiac and pulmonary complications. Troponin I (cTnI), a reliable marker of myocardial injury, is frequently raised after SAH.

Aims: To investigate the additional value of (cTnI) in predicting cardiac or pulmonary complications and outcome in patients with SAH.

Methods: Admission cTnI was measured in a prospective series of patients admitted within 24 hours of SAH. By means of univariate and multivariate logistic regression models the additional prognostic value of raised cTnI (>0.3 µg/litre) was investigated compared with established prognosticators (clinical condition on admission, age, and amount of blood on admission computed tomography) for predicting the occurrence of pulmonary oedema, pulmonary gas exchange abnormalities, rhythm disturbances, inadequate cardiac performance, a combination of these complications, and poor outcome. Area under the operator characteristic curve (AUC-ROC) was used to assess additional prognostic value.

Results: Abnormal cTnI concentrations were found on admission in 35 of 68 patients. Abnormal cTnI concentrations and poor clinical condition independently predicted cardiac or pulmonary complications. After extending the model with World Federation of Neurological Surgeons scale and age in addition to abnormal cTnI, the AUC-ROC improved from 0.70 (95% confidence interval (CI), 0.57 to 0.83) to 0.83 (95% CI, 0.72 to 0.93). Abnormal cTnI also independently predicted poor outcome. The additional prognostic value of cTnI for poor outcome is limited.

Conclusions: cTnI measurement is a powerful predictor for the occurrence of pulmonary and cardiac complications, but does not carry additional prognostic value for clinical outcome in patients with aneurysmal SAH.

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Selected References

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  1. Antman E. M., Tanasijevic M. J., Thompson B., Schactman M., McCabe C. H., Cannon C. P., Fischer G. A., Fung A. Y., Thompson C., Wybenga D. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996 Oct 31;335(18):1342–1349. doi: 10.1056/NEJM199610313351802. [DOI] [PubMed] [Google Scholar]
  2. Bernard G. R., Artigas A., Brigham K. L., Carlet J., Falke K., Hudson L., Lamy M., Legall J. R., Morris A., Spragg R. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818–824. doi: 10.1164/ajrccm.149.3.7509706. [DOI] [PubMed] [Google Scholar]
  3. Brun-Buisson C., Doyon F., Carlet J. Bacteremia and severe sepsis in adults: a multicenter prospective survey in ICUs and wards of 24 hospitals. French Bacteremia-Sepsis Study Group. Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):617–624. doi: 10.1164/ajrccm.154.3.8810595. [DOI] [PubMed] [Google Scholar]
  4. Bulsara Ketan R., McGirt Matthew J., Liao Lawrence, Villavicencio Alan T., Borel Cecil, Alexander Michael J., Friedman Allan H. Use of the peak troponin value to differentiate myocardial infarction from reversible neurogenic left ventricular dysfunction associated with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003 Mar;98(3):524–528. doi: 10.3171/jns.2003.98.3.0524. [DOI] [PubMed] [Google Scholar]
  5. Claassen Jan, Vu An, Kreiter Kurt T., Kowalski Robert G., Du Evelyn Y., Ostapkovich Noeleen, Fitzsimmons Brian-Fred M., Connolly E. Sander, Mayer Stephan A. Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage. Crit Care Med. 2004 Mar;32(3):832–838. doi: 10.1097/01.ccm.0000114830.48833.8a. [DOI] [PubMed] [Google Scholar]
  6. Deehan S. C., Grant I. S. Haemodynamic changes in neurogenic pulmonary oedema: effect of dobutamine. Intensive Care Med. 1996 Jul;22(7):672–676. doi: 10.1007/BF01709745. [DOI] [PubMed] [Google Scholar]
  7. Deibert Ellen, Barzilai Benico, Braverman Alan C., Edwards Dorothy Farrar, Aiyagari Venkatesh, Dacey Ralph, Diringer Michael. Clinical significance of elevated troponin I levels in patients with nontraumatic subarachnoid hemorrhage. J Neurosurg. 2003 Apr;98(4):741–746. doi: 10.3171/jns.2003.98.4.0741. [DOI] [PubMed] [Google Scholar]
  8. Doshi R., Neil-Dwyer G. A clinicopathological study of patients following a subarachnoid hemorrhage. J Neurosurg. 1980 Mar;52(3):295–301. doi: 10.3171/jns.1980.52.3.0295. [DOI] [PubMed] [Google Scholar]
  9. Hijdra A., Brouwers P. J., Vermeulen M., van Gijn J. Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke. 1990 Aug;21(8):1156–1161. doi: 10.1161/01.str.21.8.1156. [DOI] [PubMed] [Google Scholar]
  10. Hijdra A., van Gijn J., Nagelkerke N. J., Vermeulen M., van Crevel H. Prediction of delayed cerebral ischemia, rebleeding, and outcome after aneurysmal subarachnoid hemorrhage. Stroke. 1988 Oct;19(10):1250–1256. doi: 10.1161/01.str.19.10.1250. [DOI] [PubMed] [Google Scholar]
  11. Hop J. W., Rinkel G. J., Algra A., van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997 Mar;28(3):660–664. doi: 10.1161/01.str.28.3.660. [DOI] [PubMed] [Google Scholar]
  12. Horowitz M. B., Willet D., Keffer J. The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 1998;140(1):87–93. doi: 10.1007/s007010050063. [DOI] [PubMed] [Google Scholar]
  13. Kassell N. F., Torner J. C., Haley E. C., Jr, Jane J. A., Adams H. P., Kongable G. L. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg. 1990 Jul;73(1):18–36. doi: 10.3171/jns.1990.73.1.0018. [DOI] [PubMed] [Google Scholar]
  14. Kassell N. F., Torner J. C., Haley E. C., Jr, Jane J. A., Adams H. P., Kongable G. L. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg. 1990 Jul;73(1):18–36. doi: 10.3171/jns.1990.73.1.0018. [DOI] [PubMed] [Google Scholar]
  15. Macmillan C. S. A., Grant I. S., Andrews P. J. D. Pulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management? Intensive Care Med. 2002 Jul 6;28(8):1012–1023. doi: 10.1007/s00134-002-1382-7. [DOI] [PubMed] [Google Scholar]
  16. Masuda Takashi, Sato Kiyotaka, Yamamoto Shin-ichiro, Matsuyama Narihisa, Shimohama Takao, Matsunaga Atsuhiko, Obuchi Shuichi, Shiba Yoshitaka, Shimizu Shinobu, Izumi Tohru. Sympathetic nervous activity and myocardial damage immediately after subarachnoid hemorrhage in a unique animal model. Stroke. 2002 Jun;33(6):1671–1676. doi: 10.1161/01.str.0000016327.74392.02. [DOI] [PubMed] [Google Scholar]
  17. Naredi S., Lambert G., Edén E., Zäll S., Runnerstam M., Rydenhag B., Friberg P. Increased sympathetic nervous activity in patients with nontraumatic subarachnoid hemorrhage. Stroke. 2000 Apr;31(4):901–906. doi: 10.1161/01.str.31.4.901. [DOI] [PubMed] [Google Scholar]
  18. Parekh N., Venkatesh B., Cross D., Leditschke A., Atherton J., Miles W., Winning A., Clague A., Rickard C. Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol. 2000 Oct;36(4):1328–1335. doi: 10.1016/s0735-1097(00)00857-3. [DOI] [PubMed] [Google Scholar]
  19. Porchet F., Chioléro R., de Tribolet N. Hypotensive effect of nimodipine during treatment for aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 1995;137(1-2):62–69. doi: 10.1007/BF02188783. [DOI] [PubMed] [Google Scholar]
  20. Pugin J., Auckenthaler R., Mili N., Janssens J. P., Lew P. D., Suter P. M. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991 May;143(5 Pt 1):1121–1129. doi: 10.1164/ajrccm/143.5_Pt_1.1121. [DOI] [PubMed] [Google Scholar]
  21. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg. 1988 Jun;68(6):985–986. doi: 10.3171/jns.1988.68.6.0985. [DOI] [PubMed] [Google Scholar]
  22. Sato K., Masuda T., Izumi T. Subarachnoid hemorrhage and myocardial damage clinical and experimental studies. Jpn Heart J. 1999 Nov;40(6):683–701. doi: 10.1536/jhj.40.683. [DOI] [PubMed] [Google Scholar]
  23. Solenski N. J., Haley E. C., Jr, Kassell N. F., Kongable G., Germanson T., Truskowski L., Torner J. C. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med. 1995 Jun;23(6):1007–1017. doi: 10.1097/00003246-199506000-00004. [DOI] [PubMed] [Google Scholar]
  24. Stoutenbeek C. P., van Saene H. K., Miranda D. R., Zandstra D. F. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med. 1984;10(4):185–192. doi: 10.1007/BF00259435. [DOI] [PubMed] [Google Scholar]
  25. Tung Poyee, Kopelnik Alexander, Banki Nader, Ong Ken, Ko Nerissa, Lawton Michael T., Gress Daryl, Drew Barbara, Foster Elyse, Parmley William. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke. 2004 Jan 22;35(2):548–551. doi: 10.1161/01.STR.0000114874.96688.54. [DOI] [PubMed] [Google Scholar]
  26. Turner A., Tsamitros M., Bellomo R. Myocardial cell injury in septic shock. Crit Care Med. 1999 Sep;27(9):1775–1780. doi: 10.1097/00003246-199909000-00012. [DOI] [PubMed] [Google Scholar]
  27. van Swieten J. C., Koudstaal P. J., Visser M. C., Schouten H. J., van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988 May;19(5):604–607. doi: 10.1161/01.str.19.5.604. [DOI] [PubMed] [Google Scholar]

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