The Role of Troponin Measured on Admission to the Emergency Department in Patients with Acute Ischemic Stroke to Predict Stroke Severity and Neurological Outcome

Abstract

Objective: This study aims to investigate the prognostic value of cardiac troponin levels measured at admission to the emergency department (ED) for stroke severity assessed by the National Institutes of Health Stroke Scale (NIHSS) and neurological outcomes determined by Modified Rankin Scale (mRS) scores in patients diagnosed with acute ischemic stroke (AIS). Materials and Methods: Patients presenting to ED with a diagnosis of AIS confirmed by neuroimaging findings were included. Patients were divided into 2 groups based on troponin-I levels: elevated and normal. NIHSS during admission, 30-day all-cause mortality data, and 30-day mRS were examined. In comparisons between groups, categorical variables were evaluated with Chi-square and continuous variables were evaluated with the Mann-Whitney-U test. To determine the prognostic value of troponin with poor outcomes in stroke patients, diagnostic 2x2 tables were made. Results: The study was conducted with 200 patients. Troponin elevation was detected in 37, and mortality was significantly higher in this group. The sensitivity of troponin to predict mortality was 88.89%, and PLR (positive likelihood ratio) was 5.85 (3.89–8.79). The 30-day mRS scores were significantly higher in the elevated troponin group. NIHSS scores didn’t show a significant difference between groups. Conclusions: Troponin levels assessed at admission in AIS patients may be a prognostic marker for mortality and adverse neurological outcomes.

Keywords

• Ischemic stroke
• mortality
• troponin

Supporting Institution

none

Ethical Statement

Our study was approved by the Ankara Atatürk Sanatorium Training and Research Hospital Ethics Committee (Date: 08.03.2022, decision no: 2012-KAEK-15/2489).

Akut İskemik İnme Hastalarında Acil Servise Başvuru Sırasında Ölçülen Troponinin İnme Şiddetini ve Nörolojik Sonuçları Öngörmedeki Rolü

Abstract

Amaç: Bu çalışmanın amacı, akut iskemik inme (Aİİ) tanısı alan hastalarda acil servise (AS) başvuru sırasında ölçülen kardiyak troponin düzeylerinin, Ulusal Sağlık Enstitüleri İnme Ölçeği (NIHSS) ile değerlendirilen inme şiddeti ve Modifiye Rankin Ölçeği (mRS) ile belirlenen nörolojik sonlanımı belirlemedeki prognostik değerini araştırmaktır. Materyal ve Metot: Acil servise Aİİ tanısı ile başvuran ve tanısı nörogörüntüleme bulguları ile doğrulanan hastalar dahil edildi. Hastalar troponin I düzeylerine göre yüksek ve normal olmak üzere iki gruba ayrıldı. Başvuru sırasındaki NIHSS, 30 günlük tüm nedenlere bağlı mortalite verileri ve 30 günlük mRS incelendi. Gruplar arası karşılaştırmalarda kategorik değişkenler Ki-kare ile sürekli değişkenler ise Mann Whitney U testi ile değerlendirildi. Troponinin inme hastalarında kötü sonlanımla prognostik değerini belirlemek için, tanısal 2x2 tablolar yapıldı. Bulgular: Çalışma 200 hasta ile gerçekleştirildi. Troponin yüksekliği 37 hastada tespit edildi ve bu grupta mortalite anlamlı olarak daha yüksekti. Troponin'in mortaliteyi öngörmedeki duyarlılığı %89, PLR (pozitif olabilirilik testi) 5,85 (3,89–8,79) idi. Troponin yüksekliği olan grupta 30 günlük mRS skorları anlamlı derecede yüksekti. NIHSS skorları gruplar arasında anlamlı bir fark göstermedi. Sonuç: Aİİ hastalarında başvuru sırasında ölçülen troponin düzeyleri mortalite ve olumsuz nörolojik sonuçlar açısından prognostik bir belirteç olabilir.

Keywords

• İskemik inme
• mortalite
• troponin

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