Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery
Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery
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DOI：
10.1001/jama.2012.5502
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发表时间：
2012-06-06
影响因子：
120.7
通讯作者：
Yusuf, Salim
中科院分区：
文献类型：
--
作者：
Devereaux, P. J.;Chan, Matthew T. V.;Yusuf, Salim
研究背景：全球每年有2亿成年人接受非心脏手术，其中超过100万人将在30天内死亡。目的：确定非心脏手术后前3天第四代肌钙蛋白T（TnT）峰值测量值与30天死亡率之间的关系。2007年，至2011年1月11日。符合条件的患者年龄为45岁及以上，在接受非心脏手术后至少需要住院过夜。主要结果测量患者术后6 ~ 12小时和术后第1、2、3天的TnT水平。我们进行了考克斯回归分析，其中因变量是手术后30天的死亡率，自变量包括24个术前变量。我们重复了这项分析，增加了峰值TnT测量在第一个3术后天作为一个独立变量，并使用最小P值的方法来确定是否有TnT阈值，独立改变患者的死亡riskofdeath.Results的风险，共15 133例患者被纳入本研究。30天死亡率为1.9%（95% CI，1.7%-2.1%）。多变量分析表明，与参考组相比，11.6%的患者出现的TnT峰值至少为0.02 ng/mL，与30天死亡率较高相关（TnT峰值
Context Of the 200 million adults worldwide who undergo noncardiac surgery each year, more than 1 million will die within 30 days.Objective To determine the relationship between the peak fourth-generation troponin T (TnT) measurement in the first 3 days after noncardiac surgery and 30-day mortality.Design, Setting, and Participants A prospective, international cohort study that enrolled patients from August 6, 2007, to January 11, 2011. Eligible patients were aged 45 years and older and required at least an overnight hospital admission after having noncardiac surgery.Main Outcome Measures Patients' TnT levels were measured 6 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We undertook Cox regression analysis in which the dependent variable was mortality until 30 days after surgery, and the independent variables included 24 preoperative variables. We repeated this analysis, adding the peak TnT measurement during the first 3 postoperative days as an independent variable and used a minimum P value approach to determine if there were TnT thresholds that independently altered patients' risk of death.Results A total of 15 133 patients were included in this study. The 30-day mortality rate was 1.9% (95% CI, 1.7%-2.1%). Multivariable analysis demonstrated that peak TnT values of at least 0.02 ng/mL, occurring in 11.6% of patients, were associated with higher 30-day mortality compared with the reference group (peak TnT