Serum cardiac troponin I predicts the outcome of patients with aneurismal subarachnoid hemorrhage treated with endovascular coil embolization / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the predicting value of cardiac serum troponin I (cTnI) levels for the clinical outcome of patients with aneurismal subarachnoid hemorrhage (aSAH) after endovascular coil embolization.Methods:Patients with aSAH treated with endovascular coil embolization in the Department of Neurology, Fujian Provincial Hospital from January 2017 to December 2019 were enrolled retrospectively. The baseline data, clinical grade, serum cTnI and N-terminal-pro B-type natriuretic peptide (NT-proBNP) levels, electrocardiogram, aneurysm characteristics, endovascular treatment status, and complications of the patents were collected. The outcomes were evaluated by the modified Rankin Scale (mRS) at 90 d after onset. Poor outcome was defined as >2 points. Multivariate logistic regression analysis was used to identify the independent risk factors for poor outcomes. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum cTnI levels for poor outcomes. Results:A total of 316 patients were enrolled, among them, 256 had good outcomes (81.01%), 60 had poor outcomes (18.99%) and 13 died (4.11%). Forty-seven patients (14.87%) had elevated serum cTnI levels. The proportion of patients with elevated serum cTnI levels in the poor outcome group was significantly higher than that in the good outcome group (45% vs. 7.81%; P<0.001). Compared with the good outcome group, the Glasgow Coma Scale score of the poor outcome group was lower, and the Hunt-Hess grades and Fisher grades were higher ( P<0.001). The proportion of patients with elevated NT-proBNP levels and abnormal electrocardiogram in the poor outcome group (all P<0.001) were also significantly higher than those in the good outcome group. The proportion of receiving stent-assisted coil embolization, cerebrospinal fluid replacement and ventricular drainage, as well as the incidence of complicated with cerebral infarction, hydrocephalus, seizure and rebleeding in the poor outcome group were significantly higher than those in the good outcome group (all P<0.01). Multivariate logistic regression analysis showed that after adjusting for other confounding factors, Hunt-Hess grading 3-5 (odds ratio [ OR] 6.615, 95% confidence interval [ CI]2.158-20.278; P=0.001), Fisher grading 3-4 ( OR 3.719, 95% CI 1.479-9.352; P=0.005), cerebral infarction ( OR 15.814, 95% CI 4.978-50.235; P<0.001), rebleeding ( OR 13.324, 95% CI 2.092-84.881, P=0.006) and elevated serum cTnI levels ( OR 3.874, 95% CI 1.406-10.672; P=0.009) were significantly and independently associated with the poor outcomes, which could independently predict the poor outcomes after the onset of aSAH at 90 d. The area under the ROC curve for serum cTnI levels predicting poor outcomes was 0.747 (95% CI 0.666-0.828; P<0.001). The best cut-off value was 0.025 μg/L, the sensitivity and specificity were 60.0% and 87.9%, respectively. Conclusion:The elevated serum cTnI levels have certain predictive value for the poor outcomes of patients with aSAH after endovascular coil embolization.