Prognostic value of the elevated cardiac troponin in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Jiahui Zhao ¹ Shujuan Gu ¹ Xudong Zhao ¹ Shisong Wang ¹ Qichen Pan ¹ Cunyi Zou ^2*

• ¹ Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
• ² The First Affiliated Hospital of China Medical University, Shenyang, China

AbstractObjective: Subarachnoid hemorrhage (SAH) is a common intracranial hemorrhagic disease with a high mortality and disability rate for serious complications. In clinical practice, we found elevated serum cardiac troponin (cTn) correlated with poor prognosis in SAH. Though some literature has reported their correlation, these studies were small samples and did not make a distinction between traumatic SAH and aneurysmal SAH. Accordingly, we aim to systematically analyze the prognostic evaluation value of elevated cTn in SAH with all existing studies to provide clinical reference.Methods: We collected studies about cTn and SAH from PubMed, Medline, Embase, Web of Science, Cochrane, and Clinical Trails databases published before December 2023. The Newcastle-Ottawa scale was used to evaluatethe quality of the included studies. PRISMA and AMSTAR guidelines were followed to assess the methodological quality of the systematic review. We divided the included studies into aneurysmal subarachnoid hemorrhage (aSAH) group and total subarachnoid hemorrhage (toSAH, all included studies, both aSAH and traumatic SAH) group to analyze respectively. The pooled effect size was calculated with R studio and Stata 14.0 software.Results: In toSAH group 1559 of 6349 (24.55%) SAH patients from 33 literatures exhibited elevated cTn, and 25.0% in aSAH. In aSAH, High level of cTn was significantly related to higher mortality in the hospital (OR = 2.51, 95%CI (1.95, 3.23)) and 3 months later (OR = 2.27, 95%CI (1.47, 3.49)). An increased incidence of disturbance of consciousness (OR = 2.28, 95%CI (1.41, 3.67)), delayed cerebral ischemia (OR = 1.99, 95%CI (1.40, 2.83)), physical disability (OR = 2.39, 95%CI (1.79, 3.20)), cardiac dysfunction (OR = 3.97, 95%CI (2.95, 5.33)), arrhythmias (OR = 4.87, 95%CI (2.52, 9.41)), abnormal ventricular wall motion (OR = 8.20, 95%CI (3.70, 18.18)) and neurogenic pulmonary edema (OR = 2.76, 95%CI (1.85, 4.12)) were associated with elevated cTn. In total patients of SAH, the results were further validated.Conclusion: Elevated cTn levels were associated with poor prognosis and an increased risk of adverse events, particularly in aneurysmal SAH. Clinicians should prioritize monitoring SAH patients with elevated cTn levels and consider early intervention strategies.