Predictive value of positive high-sensitivity troponin T in intubated traumatic brain injury patients

Ayman El-Menyar, Mohammad Asim, Rifat - Latifi, Shrikant I. Bangdiwala, Hassan Al-Thani

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVEThe clinical relevance of high-sensitivity troponin T (HsTnT) in trauma patients is not well explored. In this study, the authors aimed to study the predictive value of serum HsTnT in intubated patients who had sustained traumatic brain injury (TBI).METHODSA retrospective analysis was conducted for all intubated TBI patients between 2010 and 2014 at a national level 1 trauma center. Data were analyzed and compared based on the HsTnT status on admission (group 1, negative results; and group 2, positive results). Receiver operating characteristic curves were used to determine sensitivity, specificity, and cutoff level of HsTnT to predict mortality. Time to earlier discharge from hospital or death was modeled using Cox proportional hazard models to describe the relationship between HsTnT and in-hospital mortality.RESULTSOf the 826 intubated TBI patients, 490 underwent HsTnT testing; 65.7% had positive HsTnT results. Patients in group 2 had a higher Injury Severity Score (p = 0.001) and head Abbreviated Injury Scale (AIS) score (p = 0.004) than those in group 1. In addition, group 2 patients were more likely to have lower Glasgow Coma Scale scores (p = 0.001) and more likely to experience intraventricular hemorrhage, brain edema, pneumonia, and sepsis (p = 0.001). HsTnT values positively correlated with head AIS score (r = 0.19, p = 0.001) and varied by the type of lesion and time to death. Ventilator days and length of hospital stay were more prolonged in group 2 patients (p = 0.001). Area under the curve (AUC) analysis showed that HsTnT ≥ 26.5 ng/L predicted all-cause mortality (AUC 0.75, 95% CI 0.699-0.801) with 80% sensitivity. Positive HsTnT was an independent predictor of mortality in multivariate models (adjusted OR 3.10, 95% CI 1.308-7.351) even after excluding chest injury (adjusted OR 4.18, 95% CI 1.320-13.231).CONCLUSIONSPositive HsTnT results are associated with poor outcomes in intubated patients with TBI. In this subset of patients, measuring serum HsTnT on admission is a useful tool for early risk stratification and expedited care; however, further prospective studies are warranted.

Original languageEnglish (US)
Pages (from-to)1541-1549
Number of pages9
JournalJournal of Neurosurgery
Volume129
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Troponin T
Abbreviated Injury Scale
Craniocerebral Trauma
Area Under Curve
Mortality
Traumatic Brain Injury
Length of Stay
Thoracic Injuries
Glasgow Coma Scale
Injury Severity Score
Trauma Centers
Brain Edema
Mechanical Ventilators
Hospital Mortality
Serum
Proportional Hazards Models
ROC Curve
Sepsis
Pneumonia

Keywords

  • AIS = Abbreviated Injury Scale
  • BB = beta blocker
  • cardiac troponin
  • DAI = diffuse axonal injury
  • GCS = Glasgow Coma Scale
  • head
  • high-sensitivity troponin T
  • HR = hazard ratio
  • HsTnT = high-sensitivity troponin T
  • intubation
  • IQR = interquartile range
  • ISS = Injury Severity Score
  • SBP = systolic blood pressure
  • TBI = traumatic brain injury
  • Tn = troponin
  • traumatic brain injury
  • vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Predictive value of positive high-sensitivity troponin T in intubated traumatic brain injury patients. / El-Menyar, Ayman; Asim, Mohammad; Latifi, Rifat -; Bangdiwala, Shrikant I.; Al-Thani, Hassan.

In: Journal of Neurosurgery, Vol. 129, No. 6, 01.12.2018, p. 1541-1549.

Research output: Contribution to journalArticle

El-Menyar, Ayman ; Asim, Mohammad ; Latifi, Rifat - ; Bangdiwala, Shrikant I. ; Al-Thani, Hassan. / Predictive value of positive high-sensitivity troponin T in intubated traumatic brain injury patients. In: Journal of Neurosurgery. 2018 ; Vol. 129, No. 6. pp. 1541-1549.
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title = "Predictive value of positive high-sensitivity troponin T in intubated traumatic brain injury patients",
abstract = "OBJECTIVEThe clinical relevance of high-sensitivity troponin T (HsTnT) in trauma patients is not well explored. In this study, the authors aimed to study the predictive value of serum HsTnT in intubated patients who had sustained traumatic brain injury (TBI).METHODSA retrospective analysis was conducted for all intubated TBI patients between 2010 and 2014 at a national level 1 trauma center. Data were analyzed and compared based on the HsTnT status on admission (group 1, negative results; and group 2, positive results). Receiver operating characteristic curves were used to determine sensitivity, specificity, and cutoff level of HsTnT to predict mortality. Time to earlier discharge from hospital or death was modeled using Cox proportional hazard models to describe the relationship between HsTnT and in-hospital mortality.RESULTSOf the 826 intubated TBI patients, 490 underwent HsTnT testing; 65.7{\%} had positive HsTnT results. Patients in group 2 had a higher Injury Severity Score (p = 0.001) and head Abbreviated Injury Scale (AIS) score (p = 0.004) than those in group 1. In addition, group 2 patients were more likely to have lower Glasgow Coma Scale scores (p = 0.001) and more likely to experience intraventricular hemorrhage, brain edema, pneumonia, and sepsis (p = 0.001). HsTnT values positively correlated with head AIS score (r = 0.19, p = 0.001) and varied by the type of lesion and time to death. Ventilator days and length of hospital stay were more prolonged in group 2 patients (p = 0.001). Area under the curve (AUC) analysis showed that HsTnT ≥ 26.5 ng/L predicted all-cause mortality (AUC 0.75, 95{\%} CI 0.699-0.801) with 80{\%} sensitivity. Positive HsTnT was an independent predictor of mortality in multivariate models (adjusted OR 3.10, 95{\%} CI 1.308-7.351) even after excluding chest injury (adjusted OR 4.18, 95{\%} CI 1.320-13.231).CONCLUSIONSPositive HsTnT results are associated with poor outcomes in intubated patients with TBI. In this subset of patients, measuring serum HsTnT on admission is a useful tool for early risk stratification and expedited care; however, further prospective studies are warranted.",
keywords = "AIS = Abbreviated Injury Scale, BB = beta blocker, cardiac troponin, DAI = diffuse axonal injury, GCS = Glasgow Coma Scale, head, high-sensitivity troponin T, HR = hazard ratio, HsTnT = high-sensitivity troponin T, intubation, IQR = interquartile range, ISS = Injury Severity Score, SBP = systolic blood pressure, TBI = traumatic brain injury, Tn = troponin, traumatic brain injury, vascular disorders",
author = "Ayman El-Menyar and Mohammad Asim and Latifi, {Rifat -} and Bangdiwala, {Shrikant I.} and Hassan Al-Thani",
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T1 - Predictive value of positive high-sensitivity troponin T in intubated traumatic brain injury patients

AU - El-Menyar, Ayman

AU - Asim, Mohammad

AU - Latifi, Rifat -

AU - Bangdiwala, Shrikant I.

AU - Al-Thani, Hassan

PY - 2018/12/1

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N2 - OBJECTIVEThe clinical relevance of high-sensitivity troponin T (HsTnT) in trauma patients is not well explored. In this study, the authors aimed to study the predictive value of serum HsTnT in intubated patients who had sustained traumatic brain injury (TBI).METHODSA retrospective analysis was conducted for all intubated TBI patients between 2010 and 2014 at a national level 1 trauma center. Data were analyzed and compared based on the HsTnT status on admission (group 1, negative results; and group 2, positive results). Receiver operating characteristic curves were used to determine sensitivity, specificity, and cutoff level of HsTnT to predict mortality. Time to earlier discharge from hospital or death was modeled using Cox proportional hazard models to describe the relationship between HsTnT and in-hospital mortality.RESULTSOf the 826 intubated TBI patients, 490 underwent HsTnT testing; 65.7% had positive HsTnT results. Patients in group 2 had a higher Injury Severity Score (p = 0.001) and head Abbreviated Injury Scale (AIS) score (p = 0.004) than those in group 1. In addition, group 2 patients were more likely to have lower Glasgow Coma Scale scores (p = 0.001) and more likely to experience intraventricular hemorrhage, brain edema, pneumonia, and sepsis (p = 0.001). HsTnT values positively correlated with head AIS score (r = 0.19, p = 0.001) and varied by the type of lesion and time to death. Ventilator days and length of hospital stay were more prolonged in group 2 patients (p = 0.001). Area under the curve (AUC) analysis showed that HsTnT ≥ 26.5 ng/L predicted all-cause mortality (AUC 0.75, 95% CI 0.699-0.801) with 80% sensitivity. Positive HsTnT was an independent predictor of mortality in multivariate models (adjusted OR 3.10, 95% CI 1.308-7.351) even after excluding chest injury (adjusted OR 4.18, 95% CI 1.320-13.231).CONCLUSIONSPositive HsTnT results are associated with poor outcomes in intubated patients with TBI. In this subset of patients, measuring serum HsTnT on admission is a useful tool for early risk stratification and expedited care; however, further prospective studies are warranted.

AB - OBJECTIVEThe clinical relevance of high-sensitivity troponin T (HsTnT) in trauma patients is not well explored. In this study, the authors aimed to study the predictive value of serum HsTnT in intubated patients who had sustained traumatic brain injury (TBI).METHODSA retrospective analysis was conducted for all intubated TBI patients between 2010 and 2014 at a national level 1 trauma center. Data were analyzed and compared based on the HsTnT status on admission (group 1, negative results; and group 2, positive results). Receiver operating characteristic curves were used to determine sensitivity, specificity, and cutoff level of HsTnT to predict mortality. Time to earlier discharge from hospital or death was modeled using Cox proportional hazard models to describe the relationship between HsTnT and in-hospital mortality.RESULTSOf the 826 intubated TBI patients, 490 underwent HsTnT testing; 65.7% had positive HsTnT results. Patients in group 2 had a higher Injury Severity Score (p = 0.001) and head Abbreviated Injury Scale (AIS) score (p = 0.004) than those in group 1. In addition, group 2 patients were more likely to have lower Glasgow Coma Scale scores (p = 0.001) and more likely to experience intraventricular hemorrhage, brain edema, pneumonia, and sepsis (p = 0.001). HsTnT values positively correlated with head AIS score (r = 0.19, p = 0.001) and varied by the type of lesion and time to death. Ventilator days and length of hospital stay were more prolonged in group 2 patients (p = 0.001). Area under the curve (AUC) analysis showed that HsTnT ≥ 26.5 ng/L predicted all-cause mortality (AUC 0.75, 95% CI 0.699-0.801) with 80% sensitivity. Positive HsTnT was an independent predictor of mortality in multivariate models (adjusted OR 3.10, 95% CI 1.308-7.351) even after excluding chest injury (adjusted OR 4.18, 95% CI 1.320-13.231).CONCLUSIONSPositive HsTnT results are associated with poor outcomes in intubated patients with TBI. In this subset of patients, measuring serum HsTnT on admission is a useful tool for early risk stratification and expedited care; however, further prospective studies are warranted.

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KW - BB = beta blocker

KW - cardiac troponin

KW - DAI = diffuse axonal injury

KW - GCS = Glasgow Coma Scale

KW - head

KW - high-sensitivity troponin T

KW - HR = hazard ratio

KW - HsTnT = high-sensitivity troponin T

KW - intubation

KW - IQR = interquartile range

KW - ISS = Injury Severity Score

KW - SBP = systolic blood pressure

KW - TBI = traumatic brain injury

KW - Tn = troponin

KW - traumatic brain injury

KW - vascular disorders

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