High-Sensitive Cardiac Troponin T as a Reliable Biochemical Signature for Improvements of Mortality Prediction in Patients with Intracerebral Haemorrhage

Abstract

Summary: BackgroundHigh-sensitive cardiac troponin T (hs-cTnT), as a preferred biomarker, has been used for auxiliary diagnosis and risk stratification of acute myocardial infarction. The prognostic value of hs-cTnT in intracerebral haemorrhage (ICH) remains unclear. Methods: To gauge if the hs-cTnT, either alone or combined with other risk factors, has the potential to predict in-hospital mortality among the ICH population in a diverse clinical scenario setting. We performed a multi-center, population-based, retrospective cohort study between November 2016 and December 2018. Admission hs-cTnT in serum was accessed, and additional information, including the demographics, baseline laboratory parameters. Clinical and imaging characteristic was collected as well. The primary outcome was in-hospital all-cause mortality. The associations between hs-cTnT and in-hospital death were assessed by multinomial logistic regression. We also use the Net Reclassification Index analysis strategy to address the incremental prognostic impact of hs-cTnT. Findings: Elevated high-sensitivity cardiac troponin (hs-cTnT) was observed in the entire population of 485 non-survival ICH patients, but show diversity by age, gender, and disease severity. After adjusting for confounding factors, a normalization of hs-cTnT concentrations was significantly associated with higher in-hospital death (odd's ratio 1.84, 95% CI: 1.31, 2.59, P=0.0005). Notably, patients with the highest quartile of hs-cTnT levels face a 6.98-fold higher risk of in-hospital death compared with those in the lowest quartile (OR 6.98, 95%CI 2.11-23.10; P=0.0015). More importantly, incorporating hs-cTnT into the conventional risk factor model significantly increased the C statistic in predicting in-hospital mortality (0.859 vs. 0.874; P= 0.0188). Further subgroup analyses suggested the additional prediction value of hs-cTnT was more sensitive to younger adults (P=0.0208), males (P=0.0189), and tend to those with severity ICH stage (P=0.0975). Interpretation: Elevated hs-cTnT is independently associated with an increased risk of in-hospital death. A combination of hs-cTnT and conventional risk factors promoted the prognostic value of ICH, in particular, sensitive to young adults, males, and severity stage of ICH, highlighting the value of heterogeneity and personalized care in the management of ICH. Funding Statement: This paper presents independent research funded by the significant application demonstration project of the Chengdu Science and Technology Bureau (2019-YF09-00211-SN). CY is supported by 1.3.5 project for disciplines of excellence, West China Hospital,Sichuan University (18HXFH010). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The Biomedical Research Ethics Committee of West China Hospital approved this study. The requirement for informed consent was waived for this retrospective analysis of anonymous data.