William Harvey Research Institute, Queen Mary University of London, London, UK.
William Harvey Research Institute, Queen Mary University of London, London, UK.
Br J Anaesth. 2020 May;124(5):535-543. doi: 10.1016/j.bja.2020.02.003. Epub 2020 Mar 5.
Elevated high-sensitivity troponin (hsTnT) after noncardiac surgery is associated with higher mortality, but the temporal relationship between early elevated troponin and the later development of noncardiac morbidity remains unclear.
Prospective observational study of patients aged ≥45 yr undergoing major noncardiac surgery at four UK hospitals (two masked to hsTnT). The exposure of interest was early elevated troponin, as defined by hsTnT >99th centile (≥15 ng L) within 24 h after surgery. The primary outcome was morbidity 72 h after surgery, defined by the Postoperative Morbidity Survey (POMS). Secondary outcomes were time to become morbidity-free and Clavien-Dindo ≥grade 3 complications.
Early elevated troponin (median 21 ng L [16-32]) occurred in 992 of 4335 (22.9%) patients undergoing elective noncardiac surgery (mean [standard deviation, sd] age, 65 [11] yr; 2385 [54.9%] male). Noncardiac morbidity was more frequent in 494/992 (49.8%) patients with early elevated troponin compared with 1127/3343 (33.7%) patients with hsTnT <99th centile (odds ratio [OR]=1.95; 95% confidence interval [CI], 1.69-2.25). Patients with early elevated troponin had a higher risk of proven/suspected infectious morbidity (OR=1.54; 95% CI, 1.24-1.91) and critical care utilisation (OR=2.05; 95% CI, 1.73-2.43). Clavien-Dindo ≥grade 3 complications occurred in 167/992 (16.8%) patients with early elevated troponin, compared with 319/3343 (9.5%) patients with hsTnT <99th centile (OR=1.78; 95% CI, 1.48-2.14). Absence of early elevated troponin was associated with morbidity-free recovery (OR=0.44; 95% CI, 0.39-0.51).
Early elevated troponin within 24 h of elective noncardiac surgery precedes the subsequent development of noncardiac organ dysfunction and may help stratify levels of postoperative care in real time.
非心脏手术后高敏肌钙蛋白（hsTnT）升高与死亡率升高相关，但早期升高的肌钙蛋白与非心脏术后非心脏发病率的发展之间的时间关系尚不清楚。
对在英国四家医院（其中两家对 hsTnT 进行盲法检测）接受择期非心脏手术的≥45 岁患者进行前瞻性观察性研究。研究的暴露因素为术后 24 小时内 hsTnT 高于第 99 百分位数（≥15ng/L）的早期升高的肌钙蛋白。主要结局为术后 72 小时的发病率，通过术后发病率调查（POMS）进行定义。次要结局为无发病率的时间和 Clavien-Dindo≥3 级并发症。
在接受择期非心脏手术的 4335 例患者中（平均[标准差，sd]年龄 65[11]岁；2385[54.9%]为男性），992 例（22.9%）患者出现早期升高的肌钙蛋白（中位数 21ng/L[16-32]）。与 hsTnT＜第 99 百分位数的 1127/3343 例（33.7%）患者相比，有早期升高的肌钙蛋白的 494/992 例（49.8%）患者出现非心脏发病率的频率更高（比值比[OR]为 1.95；95%置信区间[CI]为 1.69-2.25）。有早期升高的肌钙蛋白的患者发生明确/疑似感染性发病率（OR=1.54；95%CI 为 1.24-1.91）和重症监护使用率（OR=2.05；95%CI 为 1.73-2.43）的风险更高。在有早期升高的肌钙蛋白的 992 例患者中，167 例（16.8%）发生 Clavien-Dindo≥3 级并发症，与 hsTnT＜第 99 百分位数的 3343 例患者相比（9.5%）（OR=1.78；95%CI 为 1.48-2.14）。无早期升高的肌钙蛋白与无发病率的恢复相关（OR=0.44；95%CI 为 0.39-0.51）。
择期非心脏手术后 24 小时内出现早期升高的肌钙蛋白会导致随后出现非心脏器官功能障碍，可能有助于实时分层术后护理水平。
