Association between admission high-sensitivity cardiac troponin T levels and clinical outcomes in acute intracerebral hemorrhage: a prospective cohort study

BACKGROUND: Intracerebral hemorrhage remains one of the most devastating forms of stroke, associated with high mortality and disability. Cardiac injury following ICH, mediated through the brain-heart axis, may serve as a marker of disease severity. High-sensitivity cardiac troponin T, which rises rapidly after myocardial injury, has potential prognostic value in stroke-heart syndrome. The objective of this study was to determine whether elevated high-sensitivity cardiac troponin T levels at hospital admission is associated with early mortality, overall mortality, and poor functional outcome at 90 days in patients with acute intracerebral hemorrhage. METHODS: This is a prospective cohort study, which enrolled 256 patients with acute ICH admitted within 24 h of onset to the Stroke Center, Bach Mai Hospital, from February 2025 to June 2025. Baseline characteristics, hematoma features, comorbidities, and high-sensitivity cardiac troponin T levels were collected immediately upon admission. Clinical outcomes included early mortality (< seven days), overall mortality, and poor functional outcome (modified Rankin Scale score 4-6) were evaluated. Multivariate regression identified independent associations. RESULTS: Elevated high-sensitivity cardiac troponin T levels was observed in 88 patients (34.4%). These patients had significantly lower Glasgow Coma Scale scores and larger hematoma volumes. Poor functional outcome occurred in 80.7% vs., 53.6% (p-value < 0.001), overall mortality in 65.9% vs., 33.9% (p-value < 0.001), and early mortality in 54.5% vs. 22.6% (p-value < 0.001) when comparing elevated and non-elevated high-sensitivity cardiac troponin T patients, respectively. After multivariable adjustment, elevated high-sensitivity cardiac troponin T (hs-cTnT) was independently associated with poor functional outcome (OR 2.41; 95% CI 1.06-5.49) and early mortality (OR 2.85; 95% CI 1.10-7.42). An association with overall mortality was also observed (OR 2.27; 95% CI 0.97-5.27), although this did not reach statistical significance. In time-to-event analyses, patients with elevated hs-cTnT experienced a significantly shorter restricted mean survival time compared with those without hs-cTnT elevation (13.9 vs. 22.4 days), corresponding to a mean survival difference of approximately 8.5 days (95% CI -11.2 to -5.8; p < 0.001). CONCLUSION: Admission elevated high-sensitivity cardiac troponin T was associated with adverse outcomes in acute primary intracerebral hemorrhage and showed a notable association with early mortality.