Background: 

Traumatic brain injury (TBI) is a major global health problem. Little research has addressed extracranial organ dysfunction following TBI, particularly myocardial injury. Using a sensitive marker of myocardial injury—high sensitivity troponin (hsTn)—we examined the incidence of early myocardial injury following TBI and explored its association with neurological outcomes following moderate-severe TBI.

Methods: 

We conducted a pilot cohort study of 133 adult (age above 17 y) subjects enrolled in the TRACK-TBI 18-center prospective cohort study. Descriptive statistics were used to examine the incidence of myocardial injury (defined as hsTn >99th percentile for a standardized reference population) across TBI severities, and to explore the association of myocardial injury with a 6-month extended Glasgow Outcome Score among patients with moderate-severe TBI.

Results: 

The mean (SD) age of the participants was 44 (17) years, and 87 (65%) were male. Twenty-six patients (20%) developed myocardial injury following TBI; myocardial injury was present in 15% of mild TBI patients and 29% of moderate-severe TBI patients (P=0.13). Median (interquartile range) hsTn values were 3.8 ng/L (2.1, 9.0), 5.8 ng/L (4.5, 34.6), and 10.2 ng/L (3.0, 34.0) in mild, moderate, and severe TBI participants, respectively (P=0.04). Overall, 11% of participants with moderate-severe TBI and myocardial injury experienced a good outcome (6-mo extended Glasgow Outcome Score≥5) at 6 months, compared with 65% in the group that did not experience myocardial injury (P=0.01).

Conclusions: 

Myocardial injury is common following TBI, with a likely dose-response relationship with TBI severity. Early myocardial injury was associated with poor 6-month clinical outcomes following moderate-severe TBI.

中文翻译：

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创伤性脑损伤后心肌损伤的发生率和临床影响：TRACK-TBI 试点研究

背景： 

创伤性脑损伤 (TBI) 是一个主要的全球健康问题。很少有研究涉及 TBI 后的颅外器官功能障碍，尤其是心肌损伤。使用心肌损伤的敏感标志物——高敏肌钙蛋白 (hsTn)——我们检查了 TBI 后早期心肌损伤的发生率，并探讨了它与中重度 TBI 后神经学结果的关联。

方法： 

我们对参加 TRACK-TBI 18 中心前瞻性队列研究的 133 名成人（17 岁以上）受试者进行了一项试点队列研究。描述性统计用于检查不同 TBI 严重程度的心肌损伤发生率（定义为标准化参考人群的 hsTn > 第 99 个百分位数），并探讨心肌损伤与中度-严重的外伤。

结果： 

参与者的平均 (SD) 年龄为 44 (17) 岁，其中 87 人 (65%) 为男性。二十六名患者 (20%) 在 TBI 后出现心肌损伤；15% 的轻度 TBI 患者和 29% 的中重度 TBI 患者存在心肌损伤（P =0.13）。轻度、中度和重度 TBI 参与者的 hsTn 中值（四分位距）分别为 3.8 ng/L（2.1、9.0）、5.8 ng/L（4.5、34.6）和 10.2 ng/L（3.0、34.0）（P = 0.04）。总体而言，11% 的中重度 TBI 和心肌损伤参与者在 6 个月时取得了良好的结果（6 个月扩展格拉斯哥结果评分≥5），而在没有经历心肌损伤的组中，这一比例为 65%（P =0.01 ） ).

结论： 

心肌损伤在 TBI 后很常见，与 TBI 的严重程度可能存在剂量反应关系。早期心肌损伤与中重度 TBI 后较差的 6 个月临床结果相关。