Incidence and associated in-hospital mortality of myocardial injury in patients with traumatic brain injury: A systematic review and meta-analysis

Objective: Myocardial injury has not been well characterized in traumatic brain injury (TBI). We aimed to assess the pooled incidence of myocardial injury defined by elevated cardiac troponin (cTn) after TBI and explore its association with in-hospital mortality.

Methods: We searched Medline, Embase, Cochrane Library, Scopus, and Web of Science from inception to 1 January 2024, for observational studies that assessed the incidence and/or associated in-hospital mortality of elevated cTn in adult TBI patients. The incidence data was reported with proportion with 95 % confidence intervals (CIs) and 95 % prediction intervals (PIs). In-hospital mortality data was synthesized with odds ratios (ORs) with 95 % CIs and 95 % PIs. Subgroup analyses and meta-regression analyses were performed to identify the potential sources of heterogeneity, and the leave-one-out method was performed for sensitivity analysis.

Results: We included 16 studies involving 4263 participants in the meta-analysis. The overall pooled incidence of myocardial injury after TBI was 33.3 % (95 % CI, 25.2 %-42.1 %; 95 % PI, 7.3 %-66.7 %; I2 = 95.3 %). Incidence of myocardial injury was 43.4 % (95 % CI, 31.7 %-55.4 %; 95 % PI 7.3 %-84.1 %; I2 = 94.8 %) for moderate to severe TBI. Myocardial injury was associated with higher in-hospital mortality (OR, 5.62; 95 % CI, 3.59-8.78; 95 % PI, 1.35-23.38; I2 = 79.0 %) after TBI.

Conclusion: Early myocardial injury was common in adult patients with acute TBI. Furthermore, myocardial injury was associated with increased in-hospital mortality after TBI. High-quality studies are needed to elucidate the true incidence of myocardial injury and its relationship between clinical outcomes in this populations.