Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery
Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery
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DOI：
10.1016/j.bja.2018.09.002
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发表时间：
2019-02-01
影响因子：
9.8
通讯作者：
Pearse, R. M.
中科院分区：
文献类型：
--
作者：
Ackland, G. L.;Abbott, T. E. F.;Pearse, R. M.
背景：全身炎症在心血管疾病的发病机制中至关重要。由于炎症可直接导致心肌细胞损伤，我们假设，术前中性粒细胞-淋巴细胞比值 (NLR) > 4 升高所反映的已形成的全身炎症使患者易于发生围术期心肌损伤。 方法：我们前瞻性招募了 1652 名年龄 >= 45 岁、在两个英国中心接受非心脏手术的患者。术后前三天测量血清高敏肌钙蛋白 T (hsTnT) 浓度。临床医生和研究人员对肌钙蛋白结果不知情。主要结局是围手术期心肌损伤，定义为术后 3 天内 hsTnT >= 14 ng L-1。我们评估了心肌损伤是否与术前 NLR>4、循环单核细胞中活化的活性氧 (ROS) 生成或两者相关。多变量逻辑回归分析探讨了年龄、性别、NLR、修订的心脏风险指数、个体白细胞亚群和心肌损伤之间的关联。对 21 名患者进行了流式细胞术定量 ROS。数据以 n (%) 或比值比 (OR) 表示，置信区间为 95%。结果：239/1652 (14.5%) 例患者术前 NLR>4。 405/1652 (24.5%) 例患者发生心肌损伤，术前 NLR>4 的患者更常见 [OR: 2.56 (1.92-3.41)；磷
Background: Systemic inflammation is pivotal in the pathogenesis of cardiovascular disease. As inflammation can directly cause cardiomyocyte injury, we hypothesised that established systemic inflammation, as reflected by elevated preoperative neutrophil-lymphocyte ratio (NLR) > 4, predisposes patients to perioperative myocardial injury.Methods: We prospectively recruited 1652 patients aged >= 45 yr who underwent non-cardiac surgery in two UK centres. Serum high sensitivity troponin T (hsTnT) concentrations were measured on the first three postoperative days. Clinicians and investigators were blinded to the troponin results. The primary outcome was perioperative myocardial injury, defined as hsTnT >= 14 ng L-1 within 3 days after surgery. We assessed whether myocardial injury was associated with preoperative NLR>4, activated reactive oxygen species (ROS) generation in circulating monocytes, or both. Multivariable logistic regression analysis explored associations between age, sex, NLR, Revised Cardiac Risk Index, individual leukocyte subsets, and myocardial injury. Flow cytometric quantification of ROS was done in 21 patients. Data are presented as n (%) or odds ratio (OR) with 95% confidence intervals.Results: Preoperative NLR>4 was present in 239/1652 (14.5%) patients. Myocardial injury occurred in 405/1652 (24.5%) patients and was more common in patients with preoperative NLR>4 [OR: 2.56 (1.92-3.41); P