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Neurocritical Care

, Volume 8, Issue 3, pp 398–403 | Cite as

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

  • Preeti Ramappa
  • Deepak Thatai
  • William Coplin
  • Steven Gellman
  • J. Ricardo Carhuapoma
  • Ruth Quah
  • Benjamin Atkinson
  • James D. Marsh
Original Article

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.

Keywords

Troponin Subarachnoid hemorrhage Mortality Neurological outcome 

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Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Preeti Ramappa
    • 1
  • Deepak Thatai
    • 1
  • William Coplin
    • 2
  • Steven Gellman
    • 3
  • J. Ricardo Carhuapoma
    • 4
  • Ruth Quah
    • 5
  • Benjamin Atkinson
    • 2
  • James D. Marsh
    • 6
  1. 1.Division of Cardiology, Harper University HospitalWayne State UniversityDetroitUSA
  2. 2.Division of NeurologyWayne State UniversityDetroitUSA
  3. 3.Division of CardiologyHenry Ford HospitalDetroitUSA
  4. 4.Division of NeurologyThe Johns Hopkins HospitalBaltimoreUSA
  5. 5.Department of Internal MedicineWayne State University School of MedicineDetroitUSA
  6. 6.Department of Internal MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA

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