Relationship Between Serum Troponin ? Level And Prognosis Of Intracerebral Hemorrhage

Purpose: To investigate whether Serum cardiac troponin ?(cTn?)can be used as a predictor of intracerebral hemorrhage(ICH)functional outcome,and determine the value of serum cTn? for the evaluation of ICH condition and outcome judgment,so as to provide a basis for the clinical treatment of the disease and early intervention for the outcome of ICH patients.Methods: A total of 140 acute ICH patients treated in the Department of Neurology,Emergency and Neurosurgery of Shaanxi Provincial Hospital from December 2018 to February 2020 were collected as the observation group,Which was in line with the diagnostic criteria of ICH proposed by the neurology branch of the Chinese medical association in the guidelines for the diagnosis and treatment of cerebral hemorrhage in China in 2019.The Patients with ICH secondary to hemorrhagic transformation of tumor and ischemic stroke,aneurysm rupture,and arteriovenous malformation were excluded.Meanwhile,140 healthy physical examinees(control group)from Shaanxi Provincial People's Hospital were collected for retrospective analysis.The general clinical data,hematoma status and serum cTn? levels of all patients were collected.The serum cTn? levels were measured on admission immediately and at least once within 72 hours after admission to detect myocardial damage.The observation group was divided into a death group(n=27)and a survival group(n=113)according to whether the patients died at 3 months.According to the modified Rankin Scale(m RS)score of the patients at 3 months,the survival group of ICH patients was divided into favorable outcome(m RS=0-2)group(n=47)and unfavorable outcome(m RS=3-5)group(n=66).Baseline characteristics,initial and maximum levels of serum cTn? after admission were compared between the two groups,and the correlation between serum cTn? level and functional outcome of ICH patients at 3 months was analyzed.All data were statistically analyzed using SPSS 24.0 software.Results: 1.Comparison of general clinical data between group with favorable outcome and unfavorable outcome,gender,previous medical history(hypertension,diabetes,hyperlipidemia,coronary heart disease,cerebral infarction,cerebral hemorrhage,myocardial infarction,renal dysfunction,antiplatelet drugs and oral anticoagulants),INR,HB,LDL-C,CRP,GFR estimation,ICH score and hematoma enlargement at admission,the difference between the two groups was not statistically significant(P>0.05),and there was statistically significant difference in age,congestive heart failure,m RS score before admission,ICH volume,NIHSS,GCS,intraventricular hemorrhage and WBC between the two groups(P<0.05).2.The level of serum cTn? in the observation group was significantly higher than that in the healthy control group,and the difference between the two groups was statistically significant(P<0.05).there was no significant difference in serum cTn? level between the survival group and the death group(P> 0.05).There was no correlation between cTn? levels and mortality.3.The initial and maximum serum cTn? level in the group with unfavorable outcome(m RS=3-5)were higher than those in the group with favorable outcome(m RS=0-2),and the difference between the two groups was statistically significant(P<0.05).4.The maximum serum cTn? level was positively correlated with m RS score(r = 0.760,P<0.001).Multiple linear regression analysis showed that the maximum serum cTn? level was independently associated with unfavorable outcome at 3 months.5.The ROC curve was used to analyze the predictive value of serum cTn? level for acute ICH,and the area under the ROC curve that reflected the outcome was compared.The results showed that the area under the ROC curve with the initial serum cTn? level was 0.688(P=0.001).When the serum cTn? was 0.055ng/ml,its sensitivity and specificity were 68.2% and 70.2%,and the positive and negative predictive rates were 76.3% and 61.1%.The area under the ROC curve of the maximum serum cTn? level was 0.878(P<0.001).When the serum cTn? level was 0.084ng/ml,its sensitivity and specificity were 97.0% and 70.2%,and the positive and negative predictors were 78.2% and 94.3%.Conclusions: 1.Elevated serum cTn? levels were observed during hospitalization,and serum cTn? levels can be used as a predictor of the functional outcome of acute ICH.2.There was no significant correlation between serum cTn? level and mortality,and it is uncertain whether serum cTn? level can predict ICH death at 3 months.3.The maximum serum cTn? level is an independent predictor of unfavorable outcome at 3 months in ICH patients,suggesting that serum cTn? level can reflect the short-term outcome of ICH.Early attention to the changes of serum cTn? level in ICH patients can predict and estimate the changes of the patient's condition,and provide a basis for the clinical treatment of the disease and early intervention for the outcome.