title: Troponin elevation predicts critical care needs and in-hospital mortality after thrombolysis in white but not black stroke patients.
abstract: BACKGROUND
  Stroke patients undergoing intravenous thrombolysis (IVT) are at increased risk for critical care interventions and mortality. Cardiac troponin elevation is common in stroke patients; however, its prognostic significance is unclear. The present study evaluates troponin elevation as a predictor of critical care needs and mortality in post-IVT patients and describes racial differences in its predictive accuracy.
  
  
  METHODS
  Logistic regression and receiver operating characteristics (ROC) analysis were used to determine racial differences in the predictive accuracy of troponin elevation for critical care needs and mortality in post-IVT patients.
  
  
  RESULTS
  Troponin elevation predicted critical care needs in white (odds ratio [OR] 29.40, 95% confidence interval [CI] 4.86-177.81) but not black patients (OR 0.50, 95% CI 0.14-1.78; P value for interaction < .001). Adding troponin elevation to a prediction model for critical care needs in whites improved the area under the curve from 0.670 to 0.844 (P = .006); however, addition of troponin elevation did not improve the model in blacks (area under the curve 0.843 vs 0.851, P = .54). Troponin elevation was associated with in-hospital mortality in whites (OR 21.94, 95% CI 3.51-137.11) but not blacks (OR 1.10, 95% CI 0.19-6.32, P value for interaction .022).
  
  
  CONCLUSIONS
  Troponin is a useful predictor of poor outcome in white but not black post-IVT stroke patients.
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 484, Baltimore, MD, 21287, USA. Electronic address: rfaigle1@jhmi.edu.
authors.forename: Roland
authors.initials: R
authors.lastname: Faigle
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 446C, Baltimore, MD, 21287, USA. Electronic address: ebmarsh@jhmi.edu.
authors.forename: Elisabeth B
authors.initials: EB
authors.lastname: Marsh
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 446E, Baltimore, MD, 21287, USA. Electronic address: rllinas@jhmi.edu.
authors.forename: Rafael H
authors.initials: RH
authors.lastname: Llinas
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 481, Baltimore, MD, 21287, USA. Electronic address: vurruti1@jhmi.edu.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Urrutia
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 446D, Baltimore, MD, 21287, USA. Electronic address: rgottesm@jhmi.edu.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003422:Critical Care; D005260:Female; D006301:Health Services Needs and Demand; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D020521:Stroke / Q000097:blood / Q000401:mortality*; D015912:Thrombolytic Therapy / Q000379:methods; D019210:Troponin I / Q000097:blood*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Critical care needs; IV thrombolysis; Racial differences; Racial disparities; Stroke; Troponin