Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Crit Care Med. 2019 May;47(5):e412-e419. doi: 10.1097/CCM.0000000000003670.
Secretoneurin is associated with cardiomyocyte Ca handling and improves risk prediction in patients with acute myocardial dysfunction. Whether secretoneurin improves risk assessment on top of established cardiac biomarkers and European System for Cardiac Operative Risk Evaluation II in patients undergoing cardiac surgery is not known.
Prospective, observational, single-center sub-study of a multicenter study.
Prospective observational study of survival in patients undergoing cardiac surgery.
A total of 619 patients undergoing cardiac surgery.
Patients underwent either isolated coronary artery bypass graft surgery, single noncoronary artery bypass graft surgery, two procedures, or three or more procedures. Procedures other than coronary artery bypass graft were valve surgery, surgery on thoracic aorta, and other cardiac surgery.
We measured preoperative and postoperative secretoneurin concentrations and adjusted for European System for Cardiac Operative Risk Evaluation II, N-terminal pro-B-type natriuretic peptide, and cardiac troponin T concentrations in multivariate analyses. During 961 days of follow-up, 59 patients died (9.5%). Secretoneurin concentrations were higher among nonsurvivors compared with survivors, both before (168 pmol/L [quartile 1-3, 147-206 pmol/L] vs 160 pmol/L [131-193 pmol/L]; p = 0.039) and after cardiac surgery (173 pmol/L [129-217 pmol/L] vs 143 pmol/L [111-173 pmol/L]; p < 0.001). Secretoneurin concentrations decreased from preoperative to postoperative measurements in survivors, whereas we observed no significant decrease in secretoneurin concentrations among nonsurvivors. Secretoneurin concentrations were weakly correlated with established risk indices. Patients with the highest postoperative secretoneurin concentrations had worse outcome compared with patients with lower secretoneurin concentrations (p < 0.001 by the log-rank test) and postoperative secretoneurin concentrations were associated with time to death in multivariate Cox regression analysis: hazard ratio lnsecretoneurin 2.96 (95% CI, 1.46-5.99; p = 0.003). Adding postoperative secretoneurin concentrations to European System for Cardiac Operative Risk Evaluation II improved patient risk stratification, as assessed by the integrated discrimination index: 0.023 (95% CI, 0.0043-0.041; p = 0.016).
Circulating postoperative secretoneurin concentrations provide incremental prognostic information to established risk indices in patients undergoing cardiac surgery.
分泌素与心肌细胞钙处理有关，可改善急性心功能障碍患者的风险预测。在接受心脏手术的患者中，分泌素是否可以在既定的心脏生物标志物和欧洲心脏手术风险评估系统 II 之上改善风险评估尚不清楚。
多中心研究的前瞻性观察性单中心子研究。
接受心脏手术患者的前瞻性观察性生存研究。
共 619 例接受心脏手术的患者。
患者接受单纯冠状动脉旁路移植术、单一非冠状动脉旁路移植术、两种手术或三种或更多手术。除冠状动脉旁路移植术外的手术为瓣膜手术、胸主动脉手术和其他心脏手术。
我们测量了术前和术后分泌素浓度，并在多变量分析中调整了欧洲心脏手术风险评估系统 II、N 端脑利钠肽前体和心脏肌钙蛋白 T 浓度。在 961 天的随访期间，59 名患者死亡（9.5%）。与幸存者相比，非幸存者的分泌素浓度更高，术前（168pmol/L[四分位距 1-3，147-206pmol/L]与 160pmol/L[131-193pmol/L]；p=0.039）和心脏手术后（173pmol/L[129-217pmol/L]与 143pmol/L[111-173pmol/L]；p<0.001）。幸存者的分泌素浓度从术前测量到术后测量下降，而我们在非幸存者中未观察到分泌素浓度的显著下降。分泌素浓度与既定的风险指标弱相关。与较低分泌素浓度的患者相比，具有最高术后分泌素浓度的患者预后更差（对数秩检验的 p<0.001），并且术后分泌素浓度与多变量 Cox 回归分析中的死亡时间相关：风险比 lnsecretoneurin2.96（95%CI，1.46-5.99；p=0.003）。将术后分泌素浓度添加到欧洲心脏手术风险评估系统 II 中可提高患者风险分层，如综合鉴别指数评估：0.023（95%CI，0.0043-0.041；p=0.016）。
在接受心脏手术的患者中，循环术后分泌素浓度为既定风险指数提供了额外的预后信息。
