Relation of Elevated Troponin-I with Clinical Severity and Outcome of Subarachnoid Hemorrhage

Abstract

Background: Patients with subarachnoid hemorrhage (SAH) often experience myocardial injury at the time of bleeding. Cardiac dysfunction after SAH is frequently associated with elevation of serum troponin I level. Elevation of troponin I may predicts cardiopulmonary and neurological complications and poor outcome.

Objective: To describe the incidence of myocardial injury and the effects of the injury on clinical severity & 3-months functional recovery.

Methods: This prospective observational study was conducted over 72 patients with SAH in patient department of Neurology, Neurosurgery & Medicine ward of Mymensingh Medical College Hospital during the period of December 2021 to January 2024. Predictor variables reflecting demographics (age, sex, occupation), radiological (Fisher scale) and neurological (Hunt-Hess grade) information were recorded. Serum troponin I level was measured at admission, within 5 days of symptoms onset. A troponin I level e” 0.3 ng/ml was defined as an indicator of cardiac injury following SAH. Patients were interviewed at 3 months to evaluate functional recovery with Glasgow Outcome Scale (GOS). Statistics included ÷2 analysis, t-test and binary logistic regression on SPSS 27.0.

Results: Out of 72 patients 26.4% were in between 50-59 years age group & female: male ratio was 1.25. Among the risk factors, hypertension was most common (47.2%). The most frequently occurring Hunt-Hess grading was grade 3 (41.7%) & Fisher scale was score 3 (48.6%). Troponin I was elevated in 26.4% of patients & the troponin I value was strongly correlated with Hunt-Hess grade (P <0.05). On 3 months follow up, 33.3% had poor outcome on Glasgow Outcome Scale (GOS) & the troponin I value was also strongly correlated with GOS score (P<0.05). Even after controls for age, gender and Hunt- Hess grades, higher levels remained a significant predictor of poor functional recovery (P<0.05)

Conclusion: Elevated level of troponin I reflects higher incidence of myocardial injury after SAH. The present study demonstrates that raised troponin I is related to more severe neurological injury and is a predictor of poor functional recovery.