ABSTRACT: IntroductionThere are few predictors of acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS) after subarachnoid hemorrhage
(SAH). We hypothesized that cardiac troponin I, which is associated with cardiovascular morbidity, would also predict ALI.
MethodsWe prospectively enrolled 171 consecutive patients with SAH. Troponin was routinely measured on admission and the next day
and subsequently if abnormal. We prospectively recorded the maximum troponin, in-hospital events, and clinical endpoints.
ALI and ARDS were defined by standard criteria.
ResultsAcute lung injury was found in 10 patients (6%), ARDS in an additional 14 (8%), and pulmonary edema without lung injury in
9 (5%). Maximum troponin was different in patients without lung injury or pulmonary edema (0.03 [0.02–0.12] mcg/l), ALI (0.17
[0.04–1.4]), or ARDS (0.31 [0.9–1.8], P<0.001). In ROC analysis, a cutoff of 0.04mcg/l had 91% sensitivity and 42% specificity for ALI or ARDS (AUC=0.75, P<0.001). Troponin was associated with ALI or ARDS after accounting for neurologic grade in multivariate models without further
contribution from pneumonia, packed red cell transfusion, gender, tobacco use, coronary artery disease, vasospasm, depressed
ejection fraction on echocardiography, or CT grade. Lung injury was associated with worse functional outcome at 14days, but
not at 28days or 3months.
ConclusionTroponin I is associated with the development of ALI after SAH.
Neurocritical Care 04/2012; 11(2):177-182. · 2.47 Impact Factor
ABSTRACT: Higher-goal hemoglobin (hgb) and more packed red blood cell transfusions lead to worse outcomes in general critical care patients. There are few data on hgb, transfusion, and outcomes after aneurysmal subarachnoid hemorrhage (SAH).
We reviewed the daily hgb levels of 103 patients with aneurysmal SAH. Cerebral infarction was diagnosed by computed tomographic scan. We corrected for Hunt and Hess grade, age, and angiographic vasospasm in multivariate models.
Of 103 patients, the mean age was 55.3 +/- 14.5 years, 63% were women, and 29% were Hunt and Hess Grades 4 and 5; hgb values steadily declined from 12.6 +/- 1.7 g/dl the day of SAH to 10.4 +/- 1.2 g/dl by Day 14. Patients who died had lower hgb than survivors on Days 0, 1, 2, 4, 6, 10, 11, and 12 (P < or = 0.05). Higher mean hgb was associated with reduced odds of poor outcome (odds ratio, 0.57 per g/dl; 95% confidence interval [CI], 0.38-0.87; P = 0.008) after correcting for Hunt and Hess grade, age, and vasospasm; results for hgb on Days 0 and 1 were similar. Higher Day 0 (odds ratio, 0.7 per g/dl; 95% CI, 0.5-0.99; P = 0.05) and mean hgb (odds ratio, 0.57 per g/dl; 95% CI, 0.38-0.87; P = 0.009) predicted a lower risk of cerebral infarction independent of vasospasm. There were no associations between hgb and other prognostic variables.
We found that SAH patients with higher initial and mean hgb values had improved outcomes. Higher hgb in SAH patients may be beneficial. The efficacy and safety of blood transfusions to increase hgb in patients with SAH may warrant further study.
Neurosurgery 11/2006; 59(4):775-9; discussion 779-80. · 2.79 Impact Factor
International Anesthesiology Clinics 02/2004; 42(1):97-112.