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J Trauma Acute Care Surg. 2016 Mar;80(3):477-83. doi: 10.1097/TA.0000000000000916.

The role of cardiac troponin I in prognostication of patients with isolated severe traumatic brain injury.

Author information

1
From the R Adams Cowley Shock Trauma Center (B.W.B., P.F.H., D.M.S.), Baltimore, Maryland; and University of Maryland School of Medicine (S.S.C., P.F.H., D.M.S.), Baltimore, Maryland.

Abstract

BACKGROUND:

Cardiac dysfunction is frequently observed after severe traumatic brain injury (sTBI); however, its significance is poorly understood. Our study sought to elucidate the association of cardiac troponin I (cTnI) elevation with all-cause in-hospital mortality following isolated sTBI (brain Abbreviated Injury Scale score ≥3 and admission Glasgow Coma Scale score ≤8, no Abbreviated Injury Scale score ≥3 to any other bodily regions).

METHODS:

We retrospectively reviewed all adult patients (aged ≥18 years) with isolated sTBI admitted to a Level I trauma center between June 2007 and January 2014. Patients must have cTnI values within 24 hours of admission. Mortality risks were examined by Cox proportional hazard model.

RESULTS:

Of 580 patients identified, 30.9% had detectable cTnI in 24 hours of admission. The median survival time was 4.19 days (interquartile range, 1.27-11.69). When adjusted for potential confounders, patients in the highest cTnI category (≥0.21 ng/mL) had a significantly higher risk of in-hospital mortality (hazard ratio, 1.39; 95% confidence interval, 1.04-1.88) compared with patients with undetectable cTnI. Mortality risk increased with higher troponin levels (p < 0.0001). This association was more pronounced in patients aged 65 years or younger (hazard ratio, 2.28; 95% confidence interval, 1.53-3.40; p < 0.0001) while, interestingly, insignificant in those older than 65 years (p = 0.0826).

CONCLUSION:

Among patients with sTBI, cTnI elevation is associated with all-cause in-hospital mortality via a nonlinear positive trend. Age modified the effect of cTnI on mortality.

LEVEL OF EVIDENCE:

Prognostic and epidemiologic study, level III.

PMID:
26910044
PMCID:
PMC4770821
[Available on 2017-03-01]
DOI:
10.1097/TA.0000000000000916
[Indexed for MEDLINE]
Free PMC Article

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