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Published on: June 18, 2021
Cardiac Troponin Elevation and Outcome after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis
Limin Zhang1, Zhilong Wang1, Sihua Qi1
1Department of Anaesthesiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, China.
Insights
Elevated cardiac troponin (cTn) in patients with subarachnoid hemorrhage (SAH) is linked to a higher risk of delayed cerebral ischemia (DCI), poor outcomes, and death. This finding highlights the prognostic significance of cTn elevation in SAH.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- Cardiac abnormalities are common following subarachnoid hemorrhage (SAH).
- Cardiac troponin (cTn) is a key biomarker for cardiac damage, but its role after SAH is debated.
- This meta-analysis investigates the prognostic value of cTn elevation in SAH patients.
Purpose of the Study:
- To assess the association between elevated cardiac troponin (cTn) and patient outcomes after subarachnoid hemorrhage (SAH).
- To determine the risk of delayed cerebral ischemia (DCI), poor outcome (death or dependency), and mortality in SAH patients with cTn elevation.
Main Methods:
- A systematic literature search was conducted in PubMed, Embase, and Cochrane Library for observational studies up to December 31, 2014.
- Data on patient characteristics, cTn elevation, and outcomes (DCI, poor outcome, death) were extracted.
- Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model.
Main Results:
- Twelve studies comprising 2214 patients were analyzed; 30% had elevated cTn.
- cTn elevation correlated with increased risks of DCI (RR 1.48), poor outcome (RR 1.91), and death (RR 2.53).
- Elevated cTn was associated with higher rates of DCI, poor outcome, and death at 3- and 12-month follow-ups, and higher in-hospital mortality.
Conclusions:
- Elevated cardiac troponin (cTn) in subarachnoid hemorrhage (SAH) patients is a significant predictor of adverse outcomes.
- cTn elevation is associated with an increased risk of delayed cerebral ischemia (DCI), poor functional outcome, and mortality after SAH.
Background:
Cardiac abnormalities frequently occur after subarachnoid hemorrhage (SAH). Cardiac troponin (cTn) is a preferred biomarker for the diagnosis of cardiac damage, and the clinical significance of cTn elevation after SAH remains controversial. This meta-analysis was performed to assess the association between cTn elevation and patient outcomes, including delayed cerebral ischemia (DCI), poor outcome (death or dependency), and death in SAH patients.
Methods:
PubMed, Embase, and the Cochrane Library were searched for observational studies reporting an association between cTn elevation and outcome after SAH that were published before December 31, 2014. We extracted data regarding patient characteristics, cTn elevation, and outcome measurements (DCI, poor outcome, or death). Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model.
Results:
Twelve studies involving 2214 patients were included in data analysis. Elevation of cTn was observed in 30% of the patients. The cTn elevation was associated with an increased risk of DCI (RR, 1.48; 95% CI, 1.23-1.79), poor outcome (RR, 1.91; 95% CI, 1.51-2.40), and death (RR, 2.53; 95% CI, 2.04-3.12). At the 3- and 12- month follow-ups, cTn elevation was associated with higher rates of DCI (RR, 1.51; 95% CI, 1.11-2.07), poor outcome (RR, 1.91; 95% CI, 1.51-2.40), and death (RR, 2.78; 95% CI, 1.80-4.29). At in-hospital follow-ups, cTn elevation was also associated with the higher rate of death (RR, 2.33; 95% CI, 1.76-3.07).
Conclusions:
cTn elevation in SAH patients is associated with an increased risk of DCI, poor outcome, and death after SAH.
