Cardiac troponin I and acute lung injury after subarachnoid hemorrhage.
BACKGROUND
There are few predictors of acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS) after subarachnoid hemorrhage (SAH). We hypothesized that cardiac troponin I, which is associated with cardiovascular morbidity, would also predict ALI.


METHODS
We prospectively enrolled 171 consecutive patients with SAH. Troponin was routinely measured on admission and the next day and subsequently if abnormal. We prospectively recorded the maximum troponin, in-hospital events, and clinical endpoints. ALI and ARDS were defined by standard criteria.


RESULTS
Acute lung injury was found in 10 patients (6%), ARDS in an additional 14 (8%), and pulmonary edema without lung injury in 9 (5%). Maximum troponin was different in patients without lung injury or pulmonary edema (0.03 [0.02-0.12] mcg/l), ALI (0.17 [0.04-1.4]), or ARDS (0.31 [0.9-1.8], P < 0.001). In ROC analysis, a cutoff of 0.04 mcg/l had 91% sensitivity and 42% specificity for ALI or ARDS (AUC = 0.75, P < 0.001). Troponin was associated with ALI or ARDS after accounting for neurologic grade in multivariate models without further contribution from pneumonia, packed red cell transfusion, gender, tobacco use, coronary artery disease, vasospasm, depressed ejection fraction on echocardiography, or CT grade. Lung injury was associated with worse functional outcome at 14 days, but not at 28 days or 3 months.


CONCLUSIONS
Troponin I is associated with the development of ALI after SAH.
Naidech
Andrew M
AM
Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL 60611, USA. a-naidech@northwestern.edu
Bassin
Sarice L
SL
Garg
Rajeev K
RK
Ault
Michael L
ML
Bendok
Bernard R
BR
Batjer
H Hunt
HH
Watts
Charles M
CM
Bleck
Thomas P
TP
D000208:Acute Disease; D055371:Acute Lung Injury / Q000000981:diagnostic imaging / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D012128:Respiratory Distress Syndrome / Q000150:complications*; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D019210:Troponin I / Q000378:metabolism*
D019210:Troponin I