Troponin elevation predicts critical care needs and in-hospital mortality after thrombolysis in white but not black stroke patients

详细信息    查看全文

• 作者：Roland Faigle ; MD ; PhD^a ; ^{rfaigle1@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; Elisabeth B. Marsh ; MD^b ; ^{ebmarsh@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; Rafael H. Llinas ; MD^c ; ^{rllinas@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; Victor C. Urrutia ; MD^d ; ^{vurruti1@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; Rebecca F. Gottesman ; MD ; PhD^e ; ^{rgottesm@jhmi.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Stroke ; IV thrombolysis ; Troponin ; Critical care needs ; Racial differences ; Racial disparities
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：32
• 期：Complete
• 页码：3-8
• 全文大小：329 K

文摘

Stroke patients undergoing intravenous thrombolysis (IVT) are at increased risk for critical care interventions and mortality. Cardiac troponin elevation is common in stroke patients; however, its prognostic significance is unclear. The present study evaluates troponin elevation as a predictor of critical care needs and mortality in post-IVT patients and describes racial differences in its predictive accuracy.

Methods

Logistic regression and receiver operating characteristics (ROC) analysis were used to determine racial differences in the predictive accuracy of troponin elevation for critical care needs and mortality in post-IVT patients.

Results

Troponin elevation predicted critical care needs in white (odds ratio [OR] 29.40, 95% confidence interval [CI] 4.86-177.81) but not black patients (OR 0.50, 95% CI 0.14-1.78; P value for interaction < .001). Adding troponin elevation to a prediction model for critical care needs in whites improved the area under the curve from 0.670 to 0.844 (P = .006); however, addition of troponin elevation did not improve the model in blacks (area under the curve 0.843 vs 0.851, P = .54). Troponin elevation was associated with in-hospital mortality in whites (OR 21.94, 95% CI 3.51-137.11) but not blacks (OR 1.10, 95% CI 0.19-6.32, P value for interaction .022).

Conclusion

Troponin is a useful predictor of poor outcome in white but not black post-IVT stroke patients.