BACKGROUND AND PURPOSE We investigated the impact of comorbidity burden on troponin elevation, with separate consideration of neurological conditions, in patients with acute ischemic stroke (AIS). METHODS This prospective, observational cohort study consecutively enrolled patients with AIS for 2 years. Serum cardiac troponin I was repeatedly measured, and disease-related biomarkers were collected for diagnosis of preassigned comorbidities, including atrial fibrillation (AF), ischemic heart disease (IHD), myocardial hypertrophy (MH), heart failure (HF), renal insufficiency (RI), and active cancer. The severity of neurological deficits and insular cortical ischemic lesions were assessed as neurological conditions. Adjusted associations between these factors and troponin elevation were determined using a multivariate ordinal logistic regression model and area under the receiver operating characteristic curve (AUC). Cox proportional hazards model was used to determine the prognostic significance of comorbidity beyond neurological conditions. RESULTS Among 1,092 patients (66.5±12.4 years, 63.3% male), 145 (13.3%) and 335 (30.7%) had elevated (≥0.040 ng/mL) and minimally-elevated (0.040-0.010 ng/mL) troponin, respectively. In the adjusted analysis, AF, MH, HF, RI, active cancer, and neurological deficits were associated with troponin elevation. The multivariate model with six comorbidities and two neurological conditions exhibited an AUC of 0.729 (95% confidence interval [CI], 0.698-0.759). In Cox regression, AF, IHD, and HF were associated with adverse cardio-cerebrovascular events, whereas HF and active cancer were associated with mortality. CONCLUSION Troponin elevation in patients with AIS can be explained by the burden of comorbidities in combination with neurological status, which explains the prognostic significance of troponin assay.

中文翻译：

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急性缺血性中风中与肌钙蛋白升高相关的因素的解释力和预后意义。

背景和目的 我们研究了急性缺血性卒中 (AIS) 患者合并症负担对肌钙蛋白升高的影响，并单独考虑了神经系统疾病。方法 这项前瞻性观察性队列研究连续招募了 2 年的 AIS 患者。重复测量血清心肌肌钙蛋白 I，并收集疾病相关生物标志物用于诊断预先指定的合并症，包括心房颤动（AF）、缺血性心脏病（IHD）、心肌肥大（MH）、心力衰竭（HF）、肾功能不全（ RI）和活动性癌症。神经功能缺损和岛叶皮质缺血性病变的严重程度被评估为神经系统疾病。这些因素与肌钙蛋白升高之间调整后的关联是使用多变量有序逻辑回归模型和接受者操作特征曲线 (AUC) 下的面积来确定的。Cox 比例风险模型用于确定神经系统疾病以外的合并症的预后意义。结果 在 1,092 名患者（66.5±12.4 岁，63.3% 男性）中，145 名 (13.3%) 和 335 名 (30.7%) 的肌钙蛋白分别升高 (≥0.040 ng/mL) 和轻微升高 (0.040-0.010 ng/mL) . 在调整后的分析中，AF、MH、HF、RI、活动性癌症和神经功能缺陷与肌钙蛋白升高相关。具有六种合并症和两种神经系统疾病的多变量模型显示 AUC 为 0.729（95% 置信区间 [CI]，0.698-0.759）。在 Cox 回归、AF、IHD 中，和 HF 与不良心脑血管事件相关，而 HF 和活动性癌症与死亡率相关。结论 AIS 患者的肌钙蛋白升高可以用合并症的负担和神经状态相结合来解释，这解释了肌钙蛋白测定的预后意义。