You Ann Hee, Han Dong Woo, Ham Sung Yeon, Lim Wonsik, Song Young
Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul 02447, Korea.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06237, Korea.
J Clin Med. 2019 Jul 26;8(8):1111. doi: 10.3390/jcm8081111.
We retrospectively enrolled 1395 patients aged > 65 years undergoing posterior lumbar spinal fusion surgery and classified them into tertiles based on serum Alkaline Phosphatase (ALP) levels (<63, 63-79, >79 IU/L). The primary outcome was the incidence of 30-day major adverse cardiac and cerebrovascular events (MACCE; composite endpoint defined as the occurrence of ≥1 of the following events: new-onset myocardial infarction, stroke, or cardiovascular mortality). The incidence of the composite endpoint was the highest in the third serum ALP tertile (0.4% vs. 0.2% vs. 2.2% in the first, second, and third tertile, respectively, = 0.003). Multivariate analysis showed that the third serum ALP tertile was an independent predictor of the composite endpoint of MACCE (odds ratio 4.507, 95% confidence interval 1.378-14.739, = 0.013). The optimal cut-off value of preoperative serum ALP showing the best discriminatory capacity to predict postoperative MACCE (measured by receiver-operating characteristic curve analysis) was 83 IU/L (area under curve 0.694, 95% confidence interval 0.574-0.813, = 0.016). Preoperative serum ALP levels were independently associated with the composite endpoint of postoperative 30-days MACCE. We suggest that serum ALP can be used as a biomarker to predict cardiac and cerebrovascular complications following lumbar spinal fusion surgery in elderly patients.
我们回顾性纳入了1395例年龄>65岁接受后路腰椎融合手术的患者，并根据血清碱性磷酸酶（ALP）水平（<63、63 - 79、>79 IU/L）将他们分为三分位数组。主要结局是30天主要不良心脑血管事件（MACCE；复合终点定义为以下事件中至少发生1项：新发心肌梗死、中风或心血管死亡）的发生率。复合终点的发生率在血清ALP三分位数最高的组中最高（第一、第二和第三三分位数组分别为0.4%、0.2%和2.2%，P = 0.003）。多因素分析显示，血清ALP三分位数最高的组是MACCE复合终点的独立预测因素（比值比4.507，95%置信区间1.378 - 14.739，P = 0.013）。术前血清ALP显示出预测术后MACCE最佳鉴别能力的最佳截断值（通过受试者工作特征曲线分析测量）为83 IU/L（曲线下面积0.694，95%置信区间0.574 - 0.813，P = 0.016）。术前血清ALP水平与术后30天MACCE复合终点独立相关。我们建议血清ALP可作为预测老年患者腰椎融合手术后心脑血管并发症的生物标志物。
