Schuiling W J, Dennesen P J W, Tans J Th J, Kingma L M, Algra A, Rinkel G J E
Department of Neurology, Medical Centre Haaglanden, Westeinde Hospital, The Netherlands.
J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1565-9. doi: 10.1136/jnnp.2004.060913.
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.
To investigate the additional value of (cTnI) in predicting cardiac or pulmonary complications and outcome in patients with SAH.
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 microg/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.
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.
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.
动脉瘤性蛛网膜下腔出血（SAH）患者有发生心脏和肺部并发症的风险。肌钙蛋白I（cTnI）是心肌损伤的可靠标志物，SAH后其水平常升高。
研究cTnI在预测SAH患者心脏或肺部并发症及预后方面的附加价值。
对SAH后24小时内入院的一系列前瞻性患者测定入院时的cTnI。通过单因素和多因素逻辑回归模型，研究与既定预后指标（入院时临床状况、年龄和入院计算机断层扫描时的出血量）相比，cTnI升高（>0.3微克/升）在预测肺水肿、肺气体交换异常、心律失常、心脏功能不全、这些并发症的组合以及不良预后方面的附加预后价值。使用受试者工作特征曲线下面积（AUC-ROC）评估附加预后价值。
68例患者中有35例入院时cTnI浓度异常。cTnI浓度异常和临床状况差可独立预测心脏或肺部并发症。在除异常cTnI外加入世界神经外科医师联合会分级和年龄扩展模型后，AUC-ROC从0.70（95%置信区间（CI），0.57至0.83）提高到0.83（95%CI，0.72至0.93）。异常cTnI也可独立预测不良预后。cTnI对不良预后的附加预后价值有限。
cTnI测定是肺部和心脏并发症发生的有力预测指标，但对动脉瘤性SAH患者的临床结局不具有附加预后价值。
