The predictive value of high-sensitive troponin I for perioperative risk in patients undergoing gastrointestinal tumor surgery.
The predictive value of high-sensitive troponin I for perioperative risk in patients undergoing gastrointestinal tumor surgery.
复制标题
DOI：
10.1016/j.eclinm.2021.101128
复制
发表时间：
2021-10
影响因子：
15.1
通讯作者：
Zeng W
中科院分区：
文献类型：
--
作者：
Zhang Y;Xue J;Zhou L;Si J;Cheng S;Cheng K;Yu S;Ouyang M;Chen Z;Chen D;Zeng W
胃肠道肿瘤手术围术期心血管事件的发生率不容忽视，研究表明术后肌钙蛋白水平与非心脏手术的风险有关。然而，术前肌钙蛋白水平与胃肠道肿瘤手术围手术期风险之间的关系尚不清楚。因此，我们的目标是评估胃肠道肿瘤手术前高敏心肌肌钙蛋白I(hs-cTnI)在围手术期风险评估中的价值。在这项回顾性队列研究中，从2018年1月至2020年6月对1259名接受胃肠道肿瘤手术且在手术前7天内入院时进行hs-cTnI检测的患者进行了回顾性研究。主要综合终点包括住院全因死亡、急性心肌梗死、心脏骤停或室颤以及急性失代偿性心力衰竭。次要终点包括住院总天数和是否需要重症监护治疗。与hs-cTnI正常者相比，hs-cTnI增高者合并终点的可能性更大(28.2%比2.7%，P<0.01)，病死率也增加(2.4%比0.3%，P=0.057)。Hs-cTnI升高患者的总住院时间明显延长(24.8U±0.03vs19.5U±0.09，P=0.003)，需要重症监护治疗的患者也更多(22.6%vs.4.2%，P<0.001)。评估hs-cTnI预测住院死亡率的ROC曲线下面积为0.787[95%可信区间(CI)0.612~0.963，P=0.015]，联合终点为0.822[95%可信区间(CI)0.766~0.879，P<0.01]。在修订的心脏指数≤为1的患者中，hs-cTnI的阳性似然比(hs-cTnI)预测联合终点的阳性似然比为10.5。在多因素Logistic分析中，hs-cTnI是联合终点的最佳预测因子之一[优势比(OR)5·924(95%CI：2·869-12·233)，P<0·001]。HS-cTnI为胃肠道肿瘤手术患者提供了强有力的预后信息，因此根据修订的心脏指数提供了可靠的预后信息。
The incidence of cardiovascular events in perioperative period of gastrointestinal tumor surgery cannot be ignored, and studies have shown that level of postoperative troponin is related to the postoperative risk of non-cardiac surgery. However, the relationship between pre-operative troponin levels and perioperative risk of gastrointestinal tumor surgery is unclear. Thus, we aimed to evaluate the value of high-sensitive cardiac troponin I (hs-cTnI) prior to gastrointestinal tumor surgery for perioperative risk assessment. In this retrospective cohort study, 1259 patients who underwent gastrointestinal tumor surgery and had been tested for hs-cTnI on admission within 7 days prior to surgery were retrospectively recruited from January 2018 to June 2020. The primary combined endpoint including in-hospital all-cause mortality, acute myocardial infarction, cardiac arrest or ventricular fibrillation and acute decompensated heart failure. The secondary endpoint included total hospital stay and requirement of intensive care treatment. Compared with patients with normal hs-cTnI, those with elevated hs-cTnI (> 0·028 ng/ml) were more likely to experience the combined endpoint (28·2% versus 2·7%, P < 0·001) and there was also an increasing rate of in mortality in elevated hs-cTnI group (2·4% versus 0·3%, P = 0·057). The length of total hospital stay was significantly longer in patients with elevated hs-cTnI (24·8 ± 16·3 versus 19·5 ± 7·9, P = 0·003) and the number of patients requiring intensive care treatment was also higher (22·6% versus 4·2%, P < 0·001). The area under the ROC curve assessing hs-cTnI in predicting in-hospital mortality was 0·787 [95% confidence interval (CI) 0·612–0·963, P = 0·015] and for combined endpoint was 0·822 [95% CI 0·766–0·879, P < 0·001]. Hs-cTnI > 0·028 ng/ml was associated with significantly higher cardiovascular event rate in patients with the revised cardiac index ≤ 1. The positive likelihood ratio of hs-cTnI (> 0·028 ng/ml) for predicting combined endpoint reaches 10.5 in patients with Lee index = 0. In multivariate logistic analyses, hs-cTnI was one of the best predictors for the combined endpoint [odds ratio (OR) 5·924 (95%CI: 2·869–12·233), P < 0·001]. Hs-cTnI provides powerful prognostic information for patients undergoing gastrointestinal tumor surgery, and therefore provides reliable prognostic information incremental to revised cardiac index.
登录
查看更多内容
影响因子：
20.1
作者：
Kamel H;Healey JS
通讯作者：
Healey JS
影响因子：
37.8
作者：
Latini, Roberto;Masson, Serge;Cohn, Jay N.
通讯作者：
Cohn, Jay N.
影响因子：
6.2
作者：
Breitbart W;Pessin H;Rosenfeld B;Applebaum AJ;Lichtenthal WG;Li Y;Saracino RM;Marziliano AM;Masterson M;Tobias K;Fenn N
通讯作者：
Fenn N
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
影响因子：
9.8
作者：
Ackland, G. L.;Abbott, T. E. F.;Pearse, R. M.
通讯作者：
Pearse, R. M.