Der Nutzen von Troponin I zur Prädiktion des Auftretens von Vasospasmen in der transkraniellen Dopplersonographie bei Patienten mit nicht-traumatischer Subarachnoidalblutung

Elevation of Troponin I (TnI) in non-traumatic subarachnoid hemorrhage (ntSAH) patients is a well-known phenomenon and associated with cardiopulmonary complications and poor outcome. However, the use of TnI upon admission to predict the occurrence of cerebral vasospasm is discussed controversially. The current study was conducted to investigate the impact of the initial TnI value at admission on the occurrence of cerebral vasospam in ntSAH patients.

A total of 142 ntSAH-patients, who were admitted to the neurosurgical intensive care unit (ICU) between December 2014 and January 2021 were retrospectively evaluated. Blood samples were drawn at admission to determine TnI value. Each patient's demographic, radiological, medical data, and continuous measurements of transcranial Doppler sonography were analyzed. A maximum mean flow velocity (MMFV) >120 cm/sec was defined as any vasospasm. These were stratified into severe vasospasms, which were defined as at least two measurements of MMFVs >200 cm/sec or an increase of MMFV >50 cm/sec/24 hours over two consecutive days or a new neurological deterioration and mild vasospasm defined as MMFVs >120 cm/sec in absence of severe vasospasm criteria. The total study population was dichotomized into patients with an initial elevated TnI and without elevated TnI upon admission.

Elevated TnI level upon admission was found in 52 patients (36.6%), which was significantly associated with lower GCS score (p<0.001), higher WFNS score (p<0.001) and higher Fisher grade (p=0.01) at admission as well as a higher rate of ischemic brain lesions (p=0.02), higher modified Rankin Scale score (p>0.001) and increased mortality (p=0.02) at discharge. In addition, TnI was identified as an independent predictor for the occurrence of any vasospasm OR:5.55, CI:1.77-17.41, p=0.003) and severe vasospasm (OR:3.3, CI: 1.1-9.95, p=0.034) in a binary logistic analysis.

An initially elevated TnI level is an independent predictor for the occurrence of any and severe vasospasm in ICU-admitted ntSAH patients, so that TnI seems to be a helpful serum biomarker to improve ICU treatment.