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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Prediction of Troponin I on cardiopulmonary parameters within the first 24 hours after non-traumatic subarachnoidal hemorrhage in intensiv care unit patients

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  • Michael Bender - Klinik für Neurochirurgie, Justus-Liebig Universität, Giessen
  • Lars Wessels - Klinik für Neurochirurgie, Justus-Liebig Universität, Giessen
  • Dirk Schulz - Klinik für Neurochirurgie, Justus-Liebig Universität, Giessen
  • Marco Stein - Klinik für Neurochirurgie, Justus-Liebig Universität, Giessen
  • Eberhard Uhl - Klinik für Neurochirurgie, Justus-Liebig Universität, Giessen
  • Markus H. T. Reinges - Klinik für Neurochirurgie, Justus-Liebig Universität, Giessen

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.02.04

doi: 10.3205/14dgnc004, urn:nbn:de:0183-14dgnc0044

Published: May 13, 2014

© 2014 Bender et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The elevation of serum cardiac troponin I value (TNI) in patients with non-traumatic subarachnoidal hemorrhage (ntSAH) is a well-known phenomenon. However, the impact of elevated TNI on cardiopulmonary parameters (CP) within the first 24 hours after ntSAH is unknown. The present study was conducted to investigate the association between TNI and different CP in patients with ntSAH within the first 24 hours of intensive care unit (ICU) treatment.

Method: From January 2008 to October 2013 we retrospectively reviewed a consecutive group of 73 patients with ntSAH admitted to our emergency department. 2 Patients with acute cardial decompensation were excluded. Blood samples were taken of the patients to determine TNI values. We collected data on demographics, baseline Glasgow Coma Scale score (GCS), World Federation of Neurosurgical Societies score (WFNS), baseline Fisher grade (FG) as well as average arterenol application rate in µg/KG/min (AAR) and oxygen fraction in percent (OF%) within the first 24 hours of ICU treatment. The target values of systolic blood pressure were 100 to 130 mmHg for patients with non-aneurysmal SAH as well as aneurysmal SAH before clipping or coiling. After surgical or interventional treatment of ruptured aneurysms the target values of systolic blood pressure were 140 to 160 mmHg. The target value of oxygen saturation was ≥ 95%. We selected two cohorts of patients. The first group (TNI positive) was defined by a TNI value > 0,05 µg/l, the second group (TNI negative) by a TNI value ≤ 0.05µg/l. Mann-Whitney-U-Test was used for statistical evaluation. P < 0.05 was the level of significance.

Results: Data from 71 patients with a mean age of 56.3 ± 12.1 years were available for analysis. An increased TNI value was found in 18 patients (25.4%). No significant difference in the average AAR (p=0.62) and OF% (p=0.28) within the first 24 hours of ICU treatment between both groups was found. Furthermore, no significant difference between WFNS (p=0.5), GCS (p=0.65) and FG (p=0.99) was observed. In a subgroup-assay with the spearman correlation for the cohort TNI positive, a positive trend between an increased TNI value and AAR (r: 0.52) was seen.

Conclusions: Our results suggest that TNI is not a predictor for the assessed CP within the first 24 hours after ntSAH. However, to confirm this preliminary data a prospective study with a greater number of patients and more CP should be performed.