Department of Neurological Sciences, Section of Cerebrovascular Disease and Neurological Critical Care, Rush University Medical Center, Chicago, IL 60612, USA.
Neurocrit Care. 2013 Jun;18(3):368-73. doi: 10.1007/s12028-012-9813-y.
Cardiac dysfunction is a well-known complication of subarachnoid hemorrhage (SAH). Our objective was to determine the frequency of troponin abnormalities in SAH and determine its impact on in-hospital mortality.
With IRB approval, we retrospectively reviewed 225 consecutive SAH patients admitted to our institution from August 1, 2006 to June 1, 2009. Traumatic SAH patients were excluded. Data were collected on demographics, Hunt and Hess score (HH), in-hospital mortality, and peak troponin values on admission. CT images were independently reviewed and graded by the study neurologist for Fisher grade (FG) and the presence of intraventricular hemorrhage (IVH).
Among the 225 SAH patients, the mean age was 57.3 years (range, 21-90). The majority of patients were female (67%), FG 3 (75%), and had IVH (62%). Among the 201 patients with troponin I values, the mean troponin level was 0.93 (range, 0.01-25.8 ng/mL) and 47 (23%) had elevated troponin I levels. In unadjusted analysis, elevated troponin I level was significantly associated with in-hospital mortality. With multivariable logistic regression adjusting for age, HH, FG, and IVH, elevated troponin I level was no longer associated with in-hospital mortality (p. 0.34). In multivariate analysis, the independent predictors of in-mortality were age and severe grade HH (4-5).
Troponin I elevation after SAH is not an independent predictor of in-hospital mortality.
心脏功能障碍是蛛网膜下腔出血（SAH）的已知并发症。我们的目的是确定 SAH 患者肌钙蛋白异常的频率，并确定其对住院死亡率的影响。
在 IRB 批准的情况下，我们回顾性分析了 2006 年 8 月 1 日至 2009 年 6 月 1 日期间我院收治的 225 例连续 SAH 患者。排除创伤性 SAH 患者。收集人口统计学资料、Hunt 和 Hess 评分（HH）、住院死亡率以及入院时的肌钙蛋白峰值。由研究神经科医生独立对 CT 图像进行 Fisher 分级（FG）和是否存在脑室出血（IVH）评估。
在 225 例 SAH 患者中，平均年龄为 57.3 岁（范围，21-90 岁）。大多数患者为女性（67%），FG3（75%），且存在 IVH（62%）。在 201 例肌钙蛋白 I 值患者中，平均肌钙蛋白水平为 0.93（范围，0.01-25.8ng/ml），47 例（23%）肌钙蛋白 I 水平升高。在未调整分析中，肌钙蛋白 I 水平升高与住院死亡率显著相关。在多变量逻辑回归分析中，校正年龄、HH、FG 和 IVH 后，肌钙蛋白 I 水平升高与住院死亡率不再相关（p.0.34）。在多变量分析中，死亡的独立预测因子为年龄和严重 HH 分级（4-5）。
SAH 后肌钙蛋白 I 升高不是住院死亡率的独立预测因子。
