Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL 60611, USA.
Neurocrit Care. 2009;11(2):177-82. doi: 10.1007/s12028-009-9223-y. Epub 2009 Apr 30.
There are few predictors of acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS) after subarachnoid hemorrhage (SAH). We hypothesized that cardiac troponin I, which is associated with cardiovascular morbidity, would also predict ALI.
We prospectively enrolled 171 consecutive patients with SAH. Troponin was routinely measured on admission and the next day and subsequently if abnormal. We prospectively recorded the maximum troponin, in-hospital events, and clinical endpoints. ALI and ARDS were defined by standard criteria.
Acute lung injury was found in 10 patients (6%), ARDS in an additional 14 (8%), and pulmonary edema without lung injury in 9 (5%). Maximum troponin was different in patients without lung injury or pulmonary edema (0.03 [0.02-0.12] mcg/l), ALI (0.17 [0.04-1.4]), or ARDS (0.31 [0.9-1.8], P < 0.001). In ROC analysis, a cutoff of 0.04 mcg/l had 91% sensitivity and 42% specificity for ALI or ARDS (AUC = 0.75, P < 0.001). Troponin was associated with ALI or ARDS after accounting for neurologic grade in multivariate models without further contribution from pneumonia, packed red cell transfusion, gender, tobacco use, coronary artery disease, vasospasm, depressed ejection fraction on echocardiography, or CT grade. Lung injury was associated with worse functional outcome at 14 days, but not at 28 days or 3 months.
Troponin I is associated with the development of ALI after SAH.
蛛网膜下腔出血（SAH）后发生急性肺损伤（ALI）或急性呼吸窘迫综合征（ARDS）的预测因素较少。我们假设与心血管发病率相关的肌钙蛋白 I 也可以预测 ALI。
我们前瞻性地纳入了 171 例连续的 SAH 患者。肌钙蛋白在入院时和次日常规测量，如果异常则随后测量。我们前瞻性地记录了最大肌钙蛋白、住院期间的事件和临床终点。ALI 和 ARDS 按照标准标准定义。
10 例患者（6%）出现急性肺损伤，14 例患者（8%）出现 ARDS，9 例患者（5%）出现肺水肿而无肺损伤。无肺损伤或肺水肿的患者的最大肌钙蛋白值不同（0.03 [0.02-0.12] mcg/l）、ALI（0.17 [0.04-1.4]）或 ARDS（0.31 [0.9-1.8]，P < 0.001）。在 ROC 分析中，截断值为 0.04 mcg/l 时对 ALI 或 ARDS 的敏感性为 91%，特异性为 42%（AUC = 0.75，P < 0.001）。在多变量模型中，肌钙蛋白与神经功能分级相关，而与肺炎、浓缩红细胞输注、性别、吸烟、冠心病、血管痉挛、超声心动图检查射血分数降低或 CT 分级无关。肺损伤与 14 天的功能结局较差相关，但与 28 天或 3 个月无关。
肌钙蛋白 I 与 SAH 后 ALI 的发生相关。
