Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage
Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage
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DOI：
10.1159/000492395
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发表时间：
2018-01-01
影响因子：
2.9
通讯作者：
Huttner, Hagen B.
中科院分区：
文献类型：
--
作者：
Gerner, Stefan T.;Auerbeck, Katrin;Huttner, Hagen B.
背景：肌钙蛋白I是一种广泛使用的心肌损伤的可靠标志物，其水平在急性卒中护理中被常规测量。到目前为止，住院期间肌钙蛋白I升高对非创伤性脑出血（ICH）患者功能结局的影响尚不清楚。方法：观察性单中心研究，包括9年内接受保守治疗的ICH患者。根据住院期间的肌钙蛋白I峰值水平（0.500 ng/mL）对患者进行分类，并比较基线和血肿特征。进行多变量分析，以研究住院期间肌钙蛋白水平与功能结局（使用改良兰金量表（mRS;有利0-3/不利4-6）评估）和3个月和12个月后死亡率的独立相关性。为了解释可能的混杂倾向评分（PS）-匹配（1：1;卡尺0.1），解释基线特征的不平衡，以研究肌钙蛋白I值对结局的影响。结果如下：745例患者中有308例（41.3%）在住院期间观察到肌钙蛋白升高（> 0.040 ng/mL），并与入院时状态较差相关（格拉斯哥昏迷量表/国立卫生研究院卒中量表）。多变量分析显示，住院期间的肌钙蛋白I水平与12个月后的不良结局独立相关（风险比[95% CI]：1.030 [1.009-1.051]，每增加1.0 ng/mL; p = 0.005），但与死亡率无关。PS匹配后，肌钙蛋白I升高的患者（= 0.040 ng/mL）与未接受治疗的患者相比，3个月和12个月后的不良结局发生率显著更高（3个月时mRS 4-6：< 0.04 ng/mL：159/265 [60.0%]与= 0.04 ng/mL：199/266 [74.8%]; p < 0.001; 12个月时：< 0.04 ng/mL：141/248 [56.9%]与
Background: Troponin I is a widely used and reliable marker of myocardial damage and its levels are routinely measured in acute stroke care. So far, the influence of troponin I elevations during hospital stay on functional outcome in patients with atraumatic intracerebral hemorrhage (ICH) is unknown. Methods: Observational single-center study including conservatively treated ICH patients over a 9-year period. Patients were categorized according to peak troponin I level during hospital stay ( 0.500 ng/mL) and compared regarding baseline and hematoma characteristics. Multivariable analyses were performed to investigate independent associations of troponin levels during hospital stay with functional outcome -assessed using the modified Rankin Scale (mRS; favorable 0-3/unfavorable 4-6) -and mortality after 3 and 12 months. To account for possible con-founding propensity score (PS)-matching (1: 1; caliper 0.1) was performed accounting for imbalances in baseline characteristics to investigate the impact of troponin I values on outcome. Results: Troponin elevations (> 0.040 ng/mL) during hospital stay were observed in 308 out of 745 (41.3%) patients and associated with poorer status on admission (Glasgow Coma Scale/National Institute of Health Stroke Scale). Multivariable analysis revealed troponin I levels during hospital stay to be independently associated with unfavorable outcome after 12 months (risk ratio [95% CI]: 1.030 [1.009-1.051] per increment of 1.0 ng/mL; p = 0.005), but not with mortality. After PS-matching, patients with troponin I elevation (= 0.040 ng/mL) versus those without had a significant higher rate of -unfavorable outcome after 3 and 12 months (mRS 4-6 at 3 months: < 0.04 ng/mL: 159/265 [60.0%] versus = 0.04 ng/mL: 199/266 [74.8%]; p < 0.001; at 12 months: < 0.04 ng/mL: 141/248 [56.9%] versus