Hofmann Denis, Buettner Marco, Rissner Florian, Wahl Manuela, Sakka Samir G
Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Jena, Germany.
J Anesth. 2007;21(3):304-10. doi: 10.1007/s00540-007-0507-0. Epub 2007 Aug 1.
Serum myoglobin as a marker of myocardial damage and injury has been shown to be of prognostic value in patients with cardiovascular events. In this study, we analyzed the prognostic value of serum myoglobin in comparison to other parameters of muscle damage and renal function in patients after cardiac surgery.
We retrospectively analyzed data from 373 cardiac surgical patients (mean age, 66 +/- 10 years; range, 30-88 years) by using the highest levels of serum myoglobin, creatinine, and creatine phosphokinase (CK) within the first 24 h after admission to the Intensive Care Unit (ICU). Patients' severity of illness was assessed by the Acute Physiology and Chronic Health Evaluation (APACHE) II score. Predictive properties, in terms of ICU mortality and need for renal replacement therapy (RRT), were analyzed by receiver operating characteristics (ROC) statistics and described by the area under the curve (AUC).
Serum myoglobin was significantly higher in nonsurvivors (n = 29) than in survivors (n = 344; median, 1449 vs 356 microg x l(-1); P < 0.001). With respect to ICU mortality, AUCs were 0.81 for myoglobin, 0.80 for creatinine, and 0.63 for CK. For comparison, an AUC of 0.82 was found for the APACHE II score. In terms of the need for RRT, AUCs were 0.87 for myoglobin, 0.92 for creatinine, and 0.60 for CK. For both endpoints, the AUCs of myoglobin and creatinine were significantly higher than that for CK.
Serum myoglobin is associated with outcome in patients after cardiac surgery. Prediction of ICU mortality and need for RRT was comparable for myoglobin and creatinine, while both were significantly superior to CK.
血清肌红蛋白作为心肌损伤的标志物，已被证明在心血管事件患者中具有预后价值。在本研究中，我们分析了心脏手术后患者血清肌红蛋白与其他肌肉损伤和肾功能参数相比的预后价值。
我们回顾性分析了373例心脏手术患者（平均年龄66±10岁；范围30 - 88岁）的数据，采用重症监护病房（ICU）入院后24小时内血清肌红蛋白、肌酐和肌酸磷酸激酶（CK）的最高水平。通过急性生理学与慢性健康状况评估（APACHE）II评分评估患者的疾病严重程度。通过受试者工作特征（ROC）统计分析预测ICU死亡率和肾脏替代治疗（RRT）需求的特性，并以曲线下面积（AUC）描述。
非幸存者（n = 29）的血清肌红蛋白显著高于幸存者（n = 344；中位数分别为1449和356μg·L⁻¹；P < 0.001）。关于ICU死亡率，肌红蛋白的AUC为0.81，肌酐为0.80，CK为0.63。相比之下，APACHE II评分的AUC为0.82。就RRT需求而言，肌红蛋白的AUC为0.87，肌酐为0.92，CK为0.60。对于这两个终点，肌红蛋白和肌酐的AUC均显著高于CK。
血清肌红蛋白与心脏手术后患者的预后相关。肌红蛋白和肌酐对ICU死亡率和RRT需求的预测相当，而两者均显著优于CK。
