Zhang Ruoyu, Kyriss Thomas, Dippon Jürgen, Boedeker Enole, Friedel Godehard
Department of Thoracic Surgery, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany.
Department of Mathematics, University Stuttgart, Stuttgart, Germany.
Eur J Cardiothorac Surg. 2019 Feb 11. doi: 10.1093/ejcts/ezz027.
Despite the positive effects of a thoracoscopic approach on improving postoperative outcomes, the risk of major complications following thoracoscopic lobectomy is not negligible. We sought to assess the usefulness of the preoperative determination of serum biomarkers to refine risk stratification in this patient population.
From 2009 to 2017, 626 patients (285 women, 341 men; median age: 67 years) underwent thoracoscopic lobectomy or anatomical segmentectomy for confirmed or suspected early-stage lung cancer or metastasis at our institution. Preoperative serum biomarkers, including albumin, C-reactive protein, haemoglobin and lactate dehydrogenase (LDH), were examined as predictors of postoperative cardiopulmonary complications using logistic regression analyses followed by causal inference.
The 90-day mortality, cardiopulmonary complication and overall morbidity rates were 1.0%, 13.1% and 18.1%, respectively. Although serum albumin, C-reactive protein and haemoglobin were not associated with cardiopulmonary complications in regression analyses, preoperative serum LDH level emerged as an independent morbidity predictor (odds ratio 1.008, 95% confidence interval 1.002-1.013; P = 0.006). The causal inference using the covariate balancing generalized propensity score methodology demonstrated similar results and an approximately positive linear relationship between the odds of cardiopulmonary complications and preoperative serum LDH level. For every 100 U/l increase in preoperative serum LDH, a 2-fold increase in the odds of cardiopulmonary complications was observed.
Our results suggest that the preoperative serum LDH level is an independent predictor of 90-day cardiopulmonary complications following thoracoscopic lobectomy or segmentectomy, even in properly selected patients. Therefore, we recommend incorporating early serum LDH measurements as a readily available method into the risk assessment process prior to major lung resection.
尽管胸腔镜手术对改善术后结局有积极作用，但胸腔镜肺叶切除术后发生严重并发症的风险仍不可忽视。我们试图评估术前测定血清生物标志物对优化该患者群体风险分层的作用。
2009年至2017年，我院626例患者（285例女性，341例男性；中位年龄：67岁）因确诊或疑似早期肺癌或转移接受了胸腔镜肺叶切除术或解剖性肺段切除术。术前血清生物标志物，包括白蛋白、C反应蛋白、血红蛋白和乳酸脱氢酶（LDH），通过逻辑回归分析及因果推断作为术后心肺并发症的预测指标进行检测。
90天死亡率、心肺并发症发生率和总体发病率分别为1.0%、13.1%和18.1%。尽管在回归分析中血清白蛋白、C反应蛋白和血红蛋白与心肺并发症无关，但术前血清LDH水平成为独立的发病预测指标（比值比1.008，95%置信区间1.002 - 1.013；P = 0.006）。使用协变量平衡广义倾向评分方法进行的因果推断显示了相似的结果，且心肺并发症发生几率与术前血清LDH水平之间存在近似的正线性关系。术前血清LDH每升高100 U/l，观察到心肺并发症发生几率增加2倍。
我们的结果表明，即使在经过适当选择的患者中，术前血清LDH水平也是胸腔镜肺叶切除术或肺段切除术后90天心肺并发症的独立预测指标。因此，我们建议在进行主要肺切除术前，将早期血清LDH检测作为一种简便可行的方法纳入风险评估过程。
