Duello Katherine M, Nagel Jay P, Thomas Colleen S, Blackshear Joseph L, Freeman William D
Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA.
Neurocrit Care. 2015 Aug;23(1):59-65. doi: 10.1007/s12028-014-0105-6.
Troponin and brain natriuretic peptide (BNP) levels are predictors of mortality following subarachnoid hemorrhage (SAH). Prior studies used strict cutoffs for BNP elevation; however, normal levels of BNP are increased in older persons and women. We explored the association of troponin elevation and BNP elevation adjusted for sex and age with 30-day mortality.
In this retrospective cohort study of patients with SAH, collected data included peak troponin T and BNP levels. Mortality data were obtained from inpatient mortality data and available records. Troponin T elevation was defined as more than 0.10 ng/mL; BNP elevation was defined as greater than the 95th percentile reference limit by age and sex for patients without cardiovascular disease. Associations of elevated troponin T and BNP were estimated from a log-binomial regression model reporting relative risks (RRs), 95 % CIs, and P values; missing data were imputed with the sample median or most frequent category.
This study included 175 SAH patients. In single-variable analysis, peak troponin T level greater than 0.10 ng/mL was associated with increased risk in 30-day mortality (RR 4.38; 95 % CI 2.43-7.89; P < .001); there was no association with elevated peak BNP adjusted for age and sex (RR 1.13; 95 % CI 0.55-2.35; P = .74). There was no evidence suggesting that the combination of elevated peak BNP and elevated peak troponin increased the risk of 30-day mortality.
Elevated troponin was an independent predictor of 30-day mortality following SAH; however, when adjusted for age and sex, elevations in BNP did not have this association.
肌钙蛋白和脑钠肽（BNP）水平是蛛网膜下腔出血（SAH）后死亡率的预测指标。既往研究对BNP升高采用严格的临界值；然而，老年人和女性的BNP正常水平会升高。我们探讨了校正性别和年龄后的肌钙蛋白升高及BNP升高与30天死亡率的关联。
在这项SAH患者的回顾性队列研究中，收集的数据包括肌钙蛋白T和BNP的峰值水平。死亡率数据来自住院患者死亡率数据和现有记录。肌钙蛋白T升高定义为超过0.10 ng/mL；BNP升高定义为无心血管疾病患者按年龄和性别计算的第95百分位数参考限值以上。通过报告相对风险（RRs）、95%可信区间（CIs）和P值的对数二项回归模型估计肌钙蛋白T和BNP升高的关联；缺失数据用样本中位数或最常见类别进行插补。
本研究纳入了175例SAH患者。在单变量分析中，肌钙蛋白T峰值水平大于0.10 ng/mL与30天死亡率风险增加相关（RR 4.38；95%CI 2.43 - 7.89；P <.001）；校正年龄和性别后，峰值BNP升高与之无关联（RR 1.13；95%CI 0.55 - 2.35；P = 0.74）。没有证据表明峰值BNP升高与峰值肌钙蛋白升高的组合会增加30天死亡率风险。
肌钙蛋白升高是SAH后30天死亡率的独立预测指标；然而，校正年龄和性别后，BNP升高并无此关联。
