Prognostic value of elevated cardiac troponin in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
Bibliographic record
Abstract
Objective: Subarachnoid hemorrhage (SAH) is a common intracranial hemorrhagic condition associated with a high mortality rate and significant disability due to serious complications. In clinical practice, we have observed that elevated serum cardiac troponin (cTn) levels correlate with a poor prognosis in SAH. Although some studies have reported this correlation, these studies had small sample sizes and did not make a distinction between traumatic SAH and aneurysmal SAH. Accordingly, we aimed to systematically analyze the prognostic evaluation value of elevated cTn levels in SAH by reviewing all existing studies to provide a clinical reference. Methods: We selected studies on cTn and SAH from PubMed, Medline, Embase, Web of Science, Cochrane Library, and Clinical Trails databases published before December 2023. The Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. PRISMA and AMSTAR guidelines were followed to assess the methodological quality of the systematic review. We divided the included studies into two groups: aneurysmal subarachnoid hemorrhage (aSAH) group and total subarachnoid hemorrhage (toSAH) group. The total subarachnoid hemorrhage (toSAH) group included aSAH and traumatic SAH studies for analysis. The pooled effect size was calculated using R studio and Stata 14.0. Results: In the toSAH group, 1,559 out of 6,349 (24.55%) SAH patients from 33 studies exhibited elevated cTn levels, while 25.0% in the aSAH group also exhibited similar results. In the aSAH group, high levels of cTn were significantly related to increased mortality both in the hospital [OR = 2.51, 95%CI (1.95, 3.23)] and 3 months later [OR = 2.27, 95%CI (1.47, 3.49)]. An increased incidence of disturbance of consciousness [OR = 2.28, 95%CI (1.41, 3.67)], delayed cerebral ischemia (DCI) [OR = 1.99, 95%CI (1.40, 2.83)], physical disability [OR = 2.39, 95%CI (1.79, 3.20)], cardiac dysfunction [OR = 3.97, 95%CI (2.95, 5.33)], arrhythmias [OR = 4.87, 95%CI (2.52, 9.41)], abnormal ventricular wall motion [OR = 8.20, 95%CI (3.70, 18.18)], and neurogenic pulmonary edema [OR = 2.76, 95%CI (1.85, 4.12)] were associated with elevated cTn levels. In the total SAH patient group, the results were further validated. Conclusion: Elevated cTn levels were associated with a poor prognosis and an increased risk of adverse events, particularly in aneurysmal SAH. Clinicians should prioritize monitoring SAH patients with elevated cTn levels and consider early intervention strategies. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023433744, identifier: CRD42023433744.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.035 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.031 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".