What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute ischemic stroke (n=10519). Intervention: Elevated baseline troponin level vs. Low baseline acute phase troponin. Primary outcome: Inhospital mortality (HR 2.34, 95% CI 1.30-3.38).

April 1, 2021Open Access

Role of troponin as a biomarker for predicting outcome after ischemic stroke

Key Result

Elevated baseline troponin levels in acute ischemic stroke patients significantly increased the risk of inhospital mortality (HR 2.34) and mortality at the last follow-up (HR 2.01).

Study Design

Type

Meta-Analysis (n=10,519)

Structured PICO

Does an elevated baseline troponin level predict all-cause mortality in patients with acute ischemic stroke?

Population

10,519 adults with acute ischemic stroke from 19 observational studies assessing the prognostic significance of elevated baseline troponin levels on mortality.

Exposure

Elevated baseline serum troponin level

Comparator

Normal or lower baseline serum troponin level

Outcome

All-cause mortality (inhospital and at the end of last follow-up)hard clinical

Elevated baseline troponin is a significant prognostic biomarker for inhospital and long-term all-cause mortality in patients with acute ischemic stroke.

Main Result

Hazard Ratio: 2.34 (95% CI 1.3–3.38)

Limitations

Individual patient data were not available to adjust the confounding effect of variables
Differences in cutoff values, assay method, and follow-up period in the individual studies may have contributed to heterogeneity
Prognostic significance of troponin value may vary as per different subtypes of ischemic stroke
Other influential factors like the presence of cardiac disease data may disrupt the association

Abstract

BACKGROUND: After acute ischemic stroke, a higher level of troponin has been considered as an important biomarker for predicting mortality. AIM AND OBJECTIVES: The study aimed to quantitatively assess the prognostic significance of the effect of baseline troponin levels on all-cause mortality in patients with acute ischemic stroke using a meta-analysis approach. MATERIALS AND METHODS: The following electronic databases such as PubMed, Web of Science, Cochrane Central Register of Controlled Trials, TRIP Database, and ClinicalTrialsgov were used for obtaining the relevant articles from literature. Data were extracted in standardized data collection form by two independent investigators. Any disagreements were resolved by consensus. All the statistical analyses were performed in STATA software (Version 13.1). RESULTS: A total of 19 studies were included in the present meta-analysis involving a total of 10,519 patients. The pooled analysis suggested that elevated serum troponin level was associated with inhospital mortality (rate ratios RR 2.34, 95% confidence interval CI 1.30–3.38) and at the end of last follow-up mortality (RR 2.01; 95% CI 1.62–2.40). Sensitivity analysis by removing a single study by turns indicated that there was no obvious impact of any individual study on the pooled risk estimate. No significant publication bias was observed in the beg test ( P = 0.39); however, significant publication bias was observed in the egger test ( P = 0.046). CONCLUSION: Our findings indicated that a higher level of troponin might be an important prognostic biomarker for all cause in hospital and follow-up mortalities in patients with acute ischemic stroke. These study findings offer insight into further investigation in prospective studies to validate this particular association. The study was registered in OSF registries DOI's 10.17605/OSF. IO/D95GN

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