P6247Comparative analysis for the implication of serum cardiac troponin measurements by conventional versus high-sensitivity assays in patients with traumatic brain injury

Abstract

Abstract Background Stress-induced myocardial injury is not well-studied in patients with head injury. Objective To assess the prognostic implication of positive (+ve) Troponins (Tn) measurements by conventional (CTn) versus High-Sensitivity (HsTnT) assay in patients with traumatic brain injury (TBI). Methods A retrospective analysis was conducted for patients who were admitted with TBI between 2010 and 2014. Patient demographics, clinical presentation, troponin assay results, TBI lesions, and hospital outcomes were analyzed and compared based on troponin assay (CTn versus HsTnT). Results Across the study period, 946 patients withTBI were admitted; of them 654 had troponin levels measured within 24 h post-injury (CTn=252 and HsTnT=402). The mean age was 31 years and 46% had positive troponins. There were 147 deaths (22.5%); of them 54% had +ve HsTnT, 23% had +ve CTn, 16% had –ve CTn and 7% had –ve HsTnT). When the troponin was tested ≤4h post-injury, the mortality was 10.2% in patients with –ve CTn and 4% in patients with –ve HsTnT. There was no documented obvious direct cardiac injury. Overall, patients with positive troponins had lower Glasgow Coma Scale (GCS), higher Injury Severity Scores and higher rates of brain edema (p=0.001), pneumonia and sepsis (p=0.001) than those with negative troponin results. In two different models, multivariate regression analysis showed that +ve CTn and +ve HsTnT were independent predictors of mortality (OR 3.94, 95% CI: 1.65–9.42) and (OR 3.39; 95% CI 1.39–8.36); respectively, after adjusting for age, injury severity scores, GCS, TBI type, neurosurgical intervention, sepsis, and chest injury. Conclusion Stress-induced myocyte injury is high in TBI. Positive serum troponins, irrespective of the assay type, are associated with poor outcomes post-TBI. Positive HsTnT could be used for early risk stratification and prognosis in brain injury. Further studies are needed to support our findings.