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Evaluation of Cardiac Troponin and Adverse Outcomes After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

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Abstract

Several studies have demonstrated the usefulness of cardiac troponin I (cTn) levels in predicting adverse clinical outcomes of patients with anerusmal subarachnoid hemorrhage (aSAH). However, it remains unclear whether cTn levels can be a useful factor in predicting adverse neurologic and cardiovascular outcomes regarding follow-up duration. The study aimed to evaluate the clinical value of cTn elevation among patients with aSAH. A systematic literature search was performed in PubMed and Cochrane to collect original studies that compared the adverse outcomes in patients with aSAH who had elevated cTn levels and those who did not have elevated cTn levels. Data on patient demographics and outcome measurements (mortality, major disability, delayed cerebral ischemia, cardiac dysfunction, and pulmonary edema) were extracted. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were computed by fitting a random effects model. A total of 4,117 patients with aSAH were included in the meta-analysis. Elevated cTn levels was associated with a higher all-cause mortality (OR 3.64; 95% CI 2.68–4.94; I2 = 22.05%), poor major disability (OR 2.27; 95% CI 1.5–3.37; I2 = 52.07%), delayed cerebral ischemia (OR 2.10; 95% CI 1.46–3.03; I2 = 13.80%), cardiac dysfunction (OR 9.20; 95% CI 4.31–19.60; I2 = 39.89), and pulmonary edema (OR 10.32; 95% CI 5.64–18.90; I2 = 0.00%). Additionally, elevated cTn levels was associated with higher mortality in prospective studies (OR 3.66; 95% CI 2.61–5.14) as well as when compared with studies with short-term and long-term follow-up periods. Patients with aSAH who had elevated cTn levels also tended to experience poor short-term major disability (OR 2.36; 95% CI 1.48–3.76). Among patients with aSAH, elevated cTn levels was associated with higher mortality and adverse neurologic and cardiovascular outcomes. Given its clinical value, cardiac troponin levels may be included in the assessment of patients withs aSAH.

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Funding

This study received no funding.

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Authors and Affiliations

  1. Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Sahar Memar Montazerin, Gerald Chi, Homa Najafi & Fahimehalsadat Shojaei

  2. Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

    Roghayeh Marandi

  3. Baim Institute for Clinical Research, Boston, MA, USA

    Jane J. Lee

  4. Department of Neurology, Ronald Reagan at University of California, Los Angeles Medical Center, David Geffen School of Medicine at University of California, Los Angeles, CA, USA

    Jolanta Marszalek

  5. Department of Neurosurgery and Neurology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Ali Seifi

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  1. Sahar Memar Montazerin
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  2. Gerald Chi
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  4. Homa Najafi
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  6. Jane J. Lee
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  7. Jolanta Marszalek
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  8. Ali Seifi
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Contributions

Concept and design: Ali Seifi, Sahar Memar Montazerin, and Gerald Chi. Acquisition, analysis, or interpretation of data: Sahar Memar Montazerin, Gerald Chi, and Jane J. Lee. Drafting of the article: Roghayeh Marandi, Homa Najai, and Fahimehalsadat Shojaei. Critical revision of the article for important intellectual content: Ali Seifi, Jolanta Marszalek, and Sahar Memar Montazerin. All authors have read and agreed to the final version of the manuscript.

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Correspondence to Ali Seifi.

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Sahar Memar Montazerin, Gerald Chi these authors are Co-first authors.

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Memar Montazerin, S., Chi, G., Marandi, R. et al. Evaluation of Cardiac Troponin and Adverse Outcomes After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Neurocrit Care 36, 650–661 (2022). https://doi.org/10.1007/s12028-021-01368-0

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  • DOI: https://doi.org/10.1007/s12028-021-01368-0

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