Elevated Troponin I as a Marker for Unfavorable Outcomes in Acute Ischemic Stroke

Tareq Esteak; Mashfiqul Hasan; Mohammad Atiqur Rahman; Dewan Mohammad Karimul Islam; Swapan Kumar Ray; Ahmed Hosain; Sarah Alam; Tahira Zannat; Atm Hasibul Hasan; Sharif Uddin Khan

doi:10.7759/cureus.49568

Elevated Troponin I as a Marker for Unfavorable Outcomes in Acute Ischemic Stroke

Cureus. 2023 Nov 28;15(11):e49568. doi: 10.7759/cureus.49568. eCollection 2023 Nov.

Affiliations

¹ Clinical Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD.
² Endocrinology and Metabolism, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
³ Endocrinology and Metabolism, National Institute of Neurosciences and Hospital, Dhaka, BGD.
⁴ Cardiology, National Institute of Neurosciences and Hospital, Dhaka, BGD.
⁵ Pediatric Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD.
⁶ Clinical Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
⁷ Interventional Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD.

Abstract

Objective: To assess if elevated cardiac troponin I (cTnI) serves as a sign of unfavorable functional outcomes in ischemic stroke.

Methods: In this single-center prospective cohort study, 100 consecutive patients admitted with acute ischemic stroke (normal troponin I group n = 52, raised troponin I group n = 48) were included. Hospital mortality was documented in both groups; the remaining patients were followed up to 90 days. Then two groups were compared in terms of unfavorable short-term outcomes (Modified Rankin Scale > 3) and mortality. Multivariate logistic regression was conducted to determine the predictive value of elevated cTnI. The Kaplan-Meier curve was drawn and compared to determine the difference in survival between the two groups. To find out the most probable cut-off level for an unfavorable outcome, a receiver operating characteristic (ROC) analysis was conducted.

Result: A higher frequency of coronary artery disease (p=0.030), higher National Institutes of Health Stroke Scale (NIHSS) (p=0.008) score, and lower Glasgow Coma Scale (GCS) (p=0.002) was observed in raised troponin I group. Even after the exclusion of confounding elevated troponin I was found to be an independent predictor of unfavorable outcomes (adjusted odds ratio, OR 8.25 {95% confidence interval, CI: 2.65-25.75}; p<0.001). The patients with raised troponin I had a significantly lower rate of survival after 90 days (p=0.022). The elevated troponin I was observed to have a significantly high accuracy (p<0.001; area under curve, AUC: 0.768 {moderate accuracy}, 95% CI: 0 .676 to 0.861) in predicting unfavorable outcomes.

Conclusion: Elevated cTnI is independently associated with unfavorable short-term outcomes. It is also associated with a lower rate of survival.

Keywords: acute ischemic stroke (ais); gcs; kaplan-meier survival curves; modified rankin scale (mrs); nihss (national institutes of health stroke scale); receiver operating characteristic (roc) analysis; stroke mortality; troponin i.