Elevated Troponin Levels are Predictive of Mortality in Surgical Intracerebral Hemorrhage Patients
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ORIGINAL ARTICLE
Elevated Troponin Levels are Predictive of Mortality in Surgical Intracerebral Hemorrhage Patients Matthew C. Garrett Æ Ricardo J. Komotar Æ Robert M. Starke Æ Darshan Doshi Æ Marc L. Otten Æ E. Sander Connolly
Published online: 21 July 2009 Ó Humana Press Inc. 2009
Abstract Objective Elevated troponin levels are a common occurrence after ischemic stroke and subarachnoid hemorrhage (SAH), and have been described as a neurogenic form of myocardial injury. The prognostic significance of this event is controversial with numerous studies citing conflicting results. The importance of cardiac stress is of particular relevance in the operative management of intracerebral hemorrhage (ICH). To this end, we investigated whether troponin levels were an independent predictor of in-hospital mortality from all causes in surgically treated ICH patients. Methods We performed a retrospective analysis of 110 patients admitted to Columbia Presbyterian hospital between 1999 and 2007 for ICH and subsequent clot evacuation. Those with angina or recent myocardial infarction were excluded. CT scans were reviewed to determine hematoma size, location, presence of intraventricular hemorrhage (IVH) or SAH, hydrocephalus, and midline shift. Hospital records were examined for known demographic and clinical predictors of mortality. Univariate analysis was used to screen for predictive factors (P B 0.20) and these variables were entered into the final multivariable logistic regression model along with gender and age. Results Of 110 patients, 10 were excluded due to insufficient records or pre-existing cardiovascular disease. Ninety-five patients had at least one troponin level and 83 had multiple levels. Univariate analysis revealed nine
M. C. Garrett R. J. Komotar (&) R. M. Starke D. Doshi M. L. Otten E. S. Connolly Department of Neurosurgery, Columbia University, Room 431, 710 West 168th Street, New York, NY 10032, USA e-mail: [email protected]; [email protected]
factors that predicted in-hospital mortality (P < 0.20): smoking, volume of hemorrhage, midline shift, IVH, neurological status on admission, admission troponin, postsurgical troponin, warfarin use, and international normalized ratio. Only two factors were significant in the final multi-variate model: admission troponin and volume of hemorrhage. Admission troponin levels were a significant risk factor for in-hospital mortality even after controlling for hemorrhage volume, gender, and age. Conclusions Elevated cardiac troponin levels are predictive of mortality in surgically treated ICH patients and should be considered in management decisions. Implementation of cardio-protective strategies may improve outcomes in this patient population. Keywords Troponin elevation Cardiac stunning Intra-cerebral hemorrhage Clot evacuation
Introduction Intracerebral hemorrhage (ICH) accounts for approximately 10–20% of stroke [3]. Despite best available therapy, ICH continues to cause considerable morbidity and mortality, with estimates of 30-day mortality ran
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