Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
Neurocrit Care. 2022 Apr;36(2):650-661. doi: 10.1007/s12028-021-01368-0. Epub 2021 Oct 22.
Several studies have demonstrated the usefulness of cardiac troponin I (cTn) levels in predicting adverse clinical outcomes of patients with anerusmal subarachnoid hemorrhage (aSAH). However, it remains unclear whether cTn levels can be a useful factor in predicting adverse neurologic and cardiovascular outcomes regarding follow-up duration. The study aimed to evaluate the clinical value of cTn elevation among patients with aSAH. A systematic literature search was performed in PubMed and Cochrane to collect original studies that compared the adverse outcomes in patients with aSAH who had elevated cTn levels and those who did not have elevated cTn levels. Data on patient demographics and outcome measurements (mortality, major disability, delayed cerebral ischemia, cardiac dysfunction, and pulmonary edema) were extracted. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were computed by fitting a random effects model. A total of 4,117 patients with aSAH were included in the meta-analysis. Elevated cTn levels was associated with a higher all-cause mortality (OR 3.64; 95% CI 2.68-4.94; I = 22.05%), poor major disability (OR 2.27; 95% CI 1.5-3.37; I = 52.07%), delayed cerebral ischemia (OR 2.10; 95% CI 1.46-3.03; I = 13.80%), cardiac dysfunction (OR 9.20; 95% CI 4.31-19.60; I = 39.89), and pulmonary edema (OR 10.32; 95% CI 5.64-18.90; I = 0.00%). Additionally, elevated cTn levels was associated with higher mortality in prospective studies (OR 3.66; 95% CI 2.61-5.14) as well as when compared with studies with short-term and long-term follow-up periods. Patients with aSAH who had elevated cTn levels also tended to experience poor short-term major disability (OR 2.36; 95% CI 1.48-3.76). Among patients with aSAH, elevated cTn levels was associated with higher mortality and adverse neurologic and cardiovascular outcomes. Given its clinical value, cardiac troponin levels may be included in the assessment of patients withs aSAH.
几项研究已经证明心肌肌钙蛋白 I（cTn）水平在预测蛛网膜下腔出血（aSAH）患者不良临床结局方面的有用性。然而，关于随访时间，cTn 水平是否可作为预测不良神经和心血管结局的有用因素尚不清楚。本研究旨在评估 cTn 升高在 aSAH 患者中的临床价值。在 PubMed 和 Cochrane 中进行了系统的文献检索，以收集比较 cTn 升高的 aSAH 患者和 cTn 未升高的 aSAH 患者不良结局的原始研究。提取患者人口统计学和结局测量数据（死亡率、主要残疾、迟发性脑缺血、心功能障碍和肺水肿）。通过拟合随机效应模型计算汇总优势比（OR）和 95%置信区间（CI）。共有 4117 名 aSAH 患者纳入荟萃分析。cTn 升高与全因死亡率较高相关（OR 3.64；95%CI 2.68-4.94；I=22.05%）、主要残疾不良（OR 2.27；95%CI 1.5-3.37；I=52.07%）、迟发性脑缺血（OR 2.10；95%CI 1.46-3.03；I=13.80%）、心功能障碍（OR 9.20；95%CI 4.31-19.60；I=39.89%）和肺水肿（OR 10.32；95%CI 5.64-18.90；I=0.00%）相关。此外，前瞻性研究中 cTn 升高与死亡率升高相关（OR 3.66；95%CI 2.61-5.14），与短期和长期随访研究相比，cTn 升高与死亡率升高相关。cTn 升高的 aSAH 患者也倾向于发生短期主要残疾不良（OR 2.36；95%CI 1.48-3.76）。在 aSAH 患者中，cTn 升高与更高的死亡率和不良神经和心血管结局相关。鉴于其临床价值，心肌肌钙蛋白水平可能被纳入对 aSAH 患者的评估中。
