The Prognostic Value of Elevated Cardiac Troponin-I in Short-term Outcome of Acute Ischemic Stroke

Hala A. Fathy^1, , Walid M. Reda Ashour¹, Tamer S. Elserafy¹ and Mona M. Amer¹

¹Department of Neurology, Faculty of Medicine, Zagazig University

Cite this paper:
Hala A. Fathy, Walid M. Reda Ashour, Tamer S. Elserafy and Mona M. Amer. The Prognostic Value of Elevated Cardiac Troponin-I in Short-term Outcome of Acute Ischemic Stroke. International Journal of Clinical and Experimental Neurology. 2018; 6(1):1-7. doi: 10.12691/ijcen-6-1-1

Abstract

Background: Heart disease and stroke rank the second most common cause of mortality worldwide and the third most common in more developed countries. Elevated levels of serum troponin are found in 10-34% of patients with acute stroke. In addition, elevated cardiac troponin (cTnT) or cardiac troponin I (cTn-I) levels have been regarded as prognostic biomarkers of poor outcome and higher in-hospital mortality rates in acute ischemic stroke. Aim of the work: The aim of this study was to evaluate the role of cardiac troponin-I (cTn-I) as a predictive biomarker of both poor short-term outcome and in-hospital mortality in acute ischemic stroke patients. Methods: This prospective cohort study included 74 patients (30 males and 44 females) presented with acute ischemic stroke from March 2016 to December 2016. Data included clinical assessment involving detailed history taking, general examination, thorough neurological examination, laboratory data including measurement of serum level of (cTn-I) on admission, assessment of stroke severity using National Institute of Health Stroke Scale(NIHSS) within the first 48 hours of stroke onset. Stroke severity and functional outcome were assessed 2 months from stroke onset using (NIHSS) and modified Rankin scale (mRS). Results: Patients with elevated cTn-Ι level were older(mean age was 67.92(±12.77) Vs. 63.2(±13.24) years than in those with normal cTn-Ι level with no significant statistical difference, were suffering more from diabetes and TIA, having higher mean scores of NIHSS on admission (18.7±8.14 Vs 13.85±7.66 respectively, p<0.05). poor functional outcome as assessed by mRS was statistically significantly more in patients with elevated cTn-I level (42.9%) than in patients with normal level (38.3%), p<0.05.Also major neurological improvement as assessed by NIHSS was significantly less common in patients with elevated cTn-I level (7.1%) than in patients with normal cTn-I (45.0%), p<0.05. Mortality rate was also statistically higher in patients with elevated cTn-I than in patients with normal level (16.7%), p<0.05. Insular brain lesion was statistically significant more in ischemic stroke patients with elevated cTn-I level than in those with normal level(35.7% Vs 5.0 %, p<0.05). multivariate logistic regression analysis of factors predicting poor functional outcome including death in the study patient revealed that both gender [OR(95%CI) 0.142(0.024-0.821), P=0.029], diabetes [OR(95%CI) 0.151 (0.030-0.749), P=0.021], admission NIHSS score >12 [19.52 (9.59-39.73), p=0.0001] and elevated cTn-I level > 0.01ug/l [19.42(1.293-293.276), p=0.035] were significant predictors of poor outcome and in-hospital mortality. Conclusion: This study reached to a conclusion that the short-term outcome is less favorable and the stroke is more severe in ischemic stroke patients with elevated serum level of cTn-I than in those with normal level, making it a reliable prognostic predictor of both poor stroke outcome and high in-hospital mortality rates.

Keywords:
acute ischemic stroke Cardiac troponin-I short-term functional outcome

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