The Role of Troponin Measured on Admission to the Emergency Department in Patients with Acute Ischemic Stroke to Predict Stroke Severity and Neurological Outcome
Yıl 2024,
Cilt: 9 Sayı: 3, 209 - 215
Seda Yılmaz
,
Gülşah Çıkrıkçı Işık
,
Fatmanur Karaarslan
,
Şeref Kerem Çorbacıoğlu
,
Osman Korucu
,
Yunsur Çevik
Öz
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.
Etik Beyan
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).
Kaynakça
- Baron JM, Lewandrowski EL, Januzzi JL, Bajwa EK, Thompson BT, Lewandrowski KB. Measurement of high-sensitivity troponin T in noncardiac medical intensive care unit patients. Correlation to mortality and length of stay. Am J Clin Pathol. 2014;141(4):488-493. doi:10.1309/AJCPLVQQY35XTFVN
- Lippi G, Cervellin G, Sanchis-Gomar F. Predicting mortality with cardiac troponins: recent insights from meta-analyses. Diagnosis (Berl). 2019;8(1):37-49. doi:10.1515/dx-2019-0061
- Olcay HÖ, Çevik Y, Emektar E. Evaluation of radiological imaging findings and affecting factors in patients with acute ischemic stroke. Ankara Med J. 2018;(4):492‐499. doi: 10.17098/amj.497287
- Esteak T, Hasan M, Atiqur Rahman M, et al. Elevated Troponin I as a marker for unfavorable outcomes in acute ischemic stroke. Cureus. 2023;15(11):e49568. doi: 10.7759/cureus.49568
- Scheitz JF, Mochmann HC, Erdur H, et al. Prognostic relevance of cardiac troponin T levels and their dynamic changes measured with a high-sensitivity assay in acute ischaemic stroke: analyses from the TRELAS cohort. Int J Cardiol. 2014;177(3):886-893. doi:10.1016/j.ijcard.2014.10.036
- Mochmann HC, Scheitz JF, Petzold GC, et al. Coronary angiographic findings in acute ischemic stroke patients with elevated cardiac troponin: The troponin elevation in acute ischemic stroke (TRELAS) study. Circulation. 2016;133(13):1264-1271. doi:10.1161/CIRCULATIONAHA.115.018547
- Stengl H, Ganeshan R, Hellwig S, et al. Cardiomyocyte injury following acute ischemic stroke: Protocol for a prospective observational cohort study. JMIR Res Protoc. 2021;10(2):e24186. doi:10.2196/24186
- Del Brutto DJ, Rundek T, Sacco RL. Prognosis after stroke. In: Stroke Ed: Grotta JC et al. 7th Edition. Elsevier. 2022:207-220.e11. doi:10.1016/B978-0-323-69424-7.00017-X
- Zhuo Y, Qu Y, Wu J, et al. Estimation of stroke severity with National Institutes of Health Stroke Scale grading and retinal features: A cross-sectional study. Medicine (Baltimore). 2021 Aug 6;100(31):e26846. doi:10.1097/MD.0000000000026846.
- Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38(3):1091-1096. doi:10.1161/01.STR.0000258355.23810.c6
- He L, Wang J, Dong W. The clinical prognostic significance of hs-cTnT elevation in patients with acute ischemic stroke. BMC Neurol. 2018;18(1):118. doi:10.1186/s12883-018-1121-5
- Abdi S, Oveis-Gharan S, Sinaei F, Ghorbani A. Elevated troponin T after acute ischemic stroke: Association with severity and location of infarction. Iran J Neurol. 2015;14(1):35-40.
- Uzunosmanoğlu H, Korucu O, Emektar E, Çorbacıoğlu ŞK, Hacıfazlıoğlu Ç, Çevik Y. Association of trans-myocardial repolarisation parameters with size of the diffusion limitation area in acute ischaemic stroke.
Neurol Neurochir Pol. 2019;53(5):363-368. doi:10.5603/PJNNS.a2019.0041
- Scheitz JF, Sposato LA, Schulz-Menger J, Nolte CH, Backs J, Endres M. Stroke-heart syndrome: Recent advances and challenges. J Am Heart Assoc. 2022;11(17):e026528. doi:10.1161/JAHA.122.026528
- Veltkamp R, Uhlmann S, Marinescu M, et al. Experimental ischaemic stroke induces transient cardiac atrophy and dysfunction. J Cachexia Sarcopenia Muscle. 2019;10(1):54-62. doi:10.1002/jcsm.12335
- Alhazzani A, Kumar A, Algahtany M, Rawat D. Role of troponin as a biomarker for predicting outcome after ischemic stroke. Brain Circ. 2021;7(2):77-84. doi:10.4103/bc.bc_51_20
- Ahn SH, Lee JS, Yun MS, et al. Explanatory Power and Prognostic Implications of Factors Associated with Troponin Elevation in Acute Ischemic Stroke. J Stroke. 2023;25(1):141-150. doi:10.5853/jos.2022.02012
- Scheitz JF, Endres M, Mochmann HC, Audebert HJ, Nolte CH. Frequency, determinants and outcome of elevated troponin in acute ischemic stroke patients. Int J Cardiol. 2012;157(2):239-42. doi:10.1016/j.ijcard.2012.01.055
- Scheitz JF, Lim J, Broersen LHA, et al.. High-sensitivity cardiac troponin T and recurrent vascular events after first ischemic stroke. J Am Heart Assoc. 2021;10(10):e018326. doi:10.1161/JAHA.120.018326
- Kim BS, Park JJ, Chang H, et al. Association of high-sensitivity troponin I with cardiac and cerebrovascular events in patient after ischemic stroke. Cerebrovasc Dis. 2023;52(2):153-159. doi:10.1159/000525920
Akut İskemik İnme Hastalarında Acil Servise Başvuru Sırasında Ölçülen Troponinin İnme Şiddetini ve Nörolojik Sonuçları Öngörmedeki Rolü
Yıl 2024,
Cilt: 9 Sayı: 3, 209 - 215
Seda Yılmaz
,
Gülşah Çıkrıkçı Işık
,
Fatmanur Karaarslan
,
Şeref Kerem Çorbacıoğlu
,
Osman Korucu
,
Yunsur Çevik
Öz
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.
Kaynakça
- Baron JM, Lewandrowski EL, Januzzi JL, Bajwa EK, Thompson BT, Lewandrowski KB. Measurement of high-sensitivity troponin T in noncardiac medical intensive care unit patients. Correlation to mortality and length of stay. Am J Clin Pathol. 2014;141(4):488-493. doi:10.1309/AJCPLVQQY35XTFVN
- Lippi G, Cervellin G, Sanchis-Gomar F. Predicting mortality with cardiac troponins: recent insights from meta-analyses. Diagnosis (Berl). 2019;8(1):37-49. doi:10.1515/dx-2019-0061
- Olcay HÖ, Çevik Y, Emektar E. Evaluation of radiological imaging findings and affecting factors in patients with acute ischemic stroke. Ankara Med J. 2018;(4):492‐499. doi: 10.17098/amj.497287
- Esteak T, Hasan M, Atiqur Rahman M, et al. Elevated Troponin I as a marker for unfavorable outcomes in acute ischemic stroke. Cureus. 2023;15(11):e49568. doi: 10.7759/cureus.49568
- Scheitz JF, Mochmann HC, Erdur H, et al. Prognostic relevance of cardiac troponin T levels and their dynamic changes measured with a high-sensitivity assay in acute ischaemic stroke: analyses from the TRELAS cohort. Int J Cardiol. 2014;177(3):886-893. doi:10.1016/j.ijcard.2014.10.036
- Mochmann HC, Scheitz JF, Petzold GC, et al. Coronary angiographic findings in acute ischemic stroke patients with elevated cardiac troponin: The troponin elevation in acute ischemic stroke (TRELAS) study. Circulation. 2016;133(13):1264-1271. doi:10.1161/CIRCULATIONAHA.115.018547
- Stengl H, Ganeshan R, Hellwig S, et al. Cardiomyocyte injury following acute ischemic stroke: Protocol for a prospective observational cohort study. JMIR Res Protoc. 2021;10(2):e24186. doi:10.2196/24186
- Del Brutto DJ, Rundek T, Sacco RL. Prognosis after stroke. In: Stroke Ed: Grotta JC et al. 7th Edition. Elsevier. 2022:207-220.e11. doi:10.1016/B978-0-323-69424-7.00017-X
- Zhuo Y, Qu Y, Wu J, et al. Estimation of stroke severity with National Institutes of Health Stroke Scale grading and retinal features: A cross-sectional study. Medicine (Baltimore). 2021 Aug 6;100(31):e26846. doi:10.1097/MD.0000000000026846.
- Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38(3):1091-1096. doi:10.1161/01.STR.0000258355.23810.c6
- He L, Wang J, Dong W. The clinical prognostic significance of hs-cTnT elevation in patients with acute ischemic stroke. BMC Neurol. 2018;18(1):118. doi:10.1186/s12883-018-1121-5
- Abdi S, Oveis-Gharan S, Sinaei F, Ghorbani A. Elevated troponin T after acute ischemic stroke: Association with severity and location of infarction. Iran J Neurol. 2015;14(1):35-40.
- Uzunosmanoğlu H, Korucu O, Emektar E, Çorbacıoğlu ŞK, Hacıfazlıoğlu Ç, Çevik Y. Association of trans-myocardial repolarisation parameters with size of the diffusion limitation area in acute ischaemic stroke.
Neurol Neurochir Pol. 2019;53(5):363-368. doi:10.5603/PJNNS.a2019.0041
- Scheitz JF, Sposato LA, Schulz-Menger J, Nolte CH, Backs J, Endres M. Stroke-heart syndrome: Recent advances and challenges. J Am Heart Assoc. 2022;11(17):e026528. doi:10.1161/JAHA.122.026528
- Veltkamp R, Uhlmann S, Marinescu M, et al. Experimental ischaemic stroke induces transient cardiac atrophy and dysfunction. J Cachexia Sarcopenia Muscle. 2019;10(1):54-62. doi:10.1002/jcsm.12335
- Alhazzani A, Kumar A, Algahtany M, Rawat D. Role of troponin as a biomarker for predicting outcome after ischemic stroke. Brain Circ. 2021;7(2):77-84. doi:10.4103/bc.bc_51_20
- Ahn SH, Lee JS, Yun MS, et al. Explanatory Power and Prognostic Implications of Factors Associated with Troponin Elevation in Acute Ischemic Stroke. J Stroke. 2023;25(1):141-150. doi:10.5853/jos.2022.02012
- Scheitz JF, Endres M, Mochmann HC, Audebert HJ, Nolte CH. Frequency, determinants and outcome of elevated troponin in acute ischemic stroke patients. Int J Cardiol. 2012;157(2):239-42. doi:10.1016/j.ijcard.2012.01.055
- Scheitz JF, Lim J, Broersen LHA, et al.. High-sensitivity cardiac troponin T and recurrent vascular events after first ischemic stroke. J Am Heart Assoc. 2021;10(10):e018326. doi:10.1161/JAHA.120.018326
- Kim BS, Park JJ, Chang H, et al. Association of high-sensitivity troponin I with cardiac and cerebrovascular events in patient after ischemic stroke. Cerebrovasc Dis. 2023;52(2):153-159. doi:10.1159/000525920