Cai Stephen S, Bonds Brandon W, Hu Peter F, Stein Deborah M
From the R Adams Cowley Shock Trauma Center (B.W.B., P.F.H., D.M.S.), Baltimore, Maryland; and University of Maryland School of Medicine (S.S.C., P.F.H., D.M.S.), Baltimore, Maryland.
J Trauma Acute Care Surg. 2016 Mar;80(3):477-83. doi: 10.1097/TA.0000000000000916.
Cardiac dysfunction is frequently observed after severe traumatic brain injury (sTBI); however, its significance is poorly understood. Our study sought to elucidate the association of cardiac troponin I (cTnI) elevation with all-cause in-hospital mortality following isolated sTBI (brain Abbreviated Injury Scale score ≥3 and admission Glasgow Coma Scale score ≤8, no Abbreviated Injury Scale score ≥3 to any other bodily regions).
We retrospectively reviewed all adult patients (aged ≥18 years) with isolated sTBI admitted to a Level I trauma center between June 2007 and January 2014. Patients must have cTnI values within 24 hours of admission. Mortality risks were examined by Cox proportional hazard model.
Of 580 patients identified, 30.9% had detectable cTnI in 24 hours of admission. The median survival time was 4.19 days (interquartile range, 1.27-11.69). When adjusted for potential confounders, patients in the highest cTnI category (≥0.21 ng/mL) had a significantly higher risk of in-hospital mortality (hazard ratio, 1.39; 95% confidence interval, 1.04-1.88) compared with patients with undetectable cTnI. Mortality risk increased with higher troponin levels (p < 0.0001). This association was more pronounced in patients aged 65 years or younger (hazard ratio, 2.28; 95% confidence interval, 1.53-3.40; p < 0.0001) while, interestingly, insignificant in those older than 65 years (p = 0.0826).
Among patients with sTBI, cTnI elevation is associated with all-cause in-hospital mortality via a nonlinear positive trend. Age modified the effect of cTnI on mortality.
Prognostic and epidemiologic study, level III.
严重创伤性脑损伤（sTBI）后常出现心脏功能障碍；然而，其重要性尚未得到充分理解。我们的研究旨在阐明孤立性sTBI（脑损伤简略量表评分≥3且入院时格拉斯哥昏迷量表评分≤8，其他身体部位损伤简略量表评分无≥3）后心肌肌钙蛋白I（cTnI）升高与全因院内死亡率之间的关联。
我们回顾性分析了2007年6月至2014年1月期间入住一级创伤中心的所有成年（年龄≥18岁）孤立性sTBI患者。患者入院24小时内必须有cTnI值。通过Cox比例风险模型检查死亡风险。
在580例确诊患者中，30.9%在入院24小时内可检测到cTnI。中位生存时间为4.19天（四分位间距，1.27 - 11.69）。在对潜在混杂因素进行校正后，与cTnI检测不到的患者相比，cTnI最高类别（≥0.21 ng/mL）的患者院内死亡风险显著更高（风险比，1.39；95%置信区间，1.04 - 1.88）。死亡风险随肌钙蛋白水平升高而增加（p < 0.0001）。这种关联在65岁及以下患者中更为明显（风险比，2.28；95%置信区间，1.53 - 3.40；p < 0.0001），而有趣的是，在65岁以上患者中不显著（p = 0.0826）。
在sTBI患者中，cTnI升高通过非线性正相关趋势与全因院内死亡率相关。年龄改变了cTnI对死亡率的影响。
预后和流行病学研究，III级。
