Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
J Cardiothorac Vasc Anesth. 2021 Aug;35(8):2415-2423. doi: 10.1053/j.jvca.2020.10.049. Epub 2020 Nov 2.
Elevated soluble urokinase-type plasminogen activator receptor (suPAR) and high-sensitivity C-reactive protein (hsCRP) have been associated with increased mortality in patients with cardiovascular disease. The aim of the present study was to explore the relationship between suPAR and hsCRP values and associated mortality after elective cardiac surgery. A secondary aim was to assess whether a combined risk model of European System for Cardiac Operative Risk Evaluation (EuroSCORE II), suPAR, and/or hsCRP would improve the prognostic accuracy compared with EuroSCORE II alone.
Retrospective observational study.
Single-center, university hospital.
Adult patients admitted for elective on-pump cardiac surgery were included. Biobank blood samples were obtained from previous research projects at a tertiary heart center from 2012 to 2018.
None.
A total of 931 patients were included. Kaplan-Meier and Cox proportional hazard analyses were used to explore a potential association between preoperative suPAR and hsCRP values and all-cause mortality up to one year after surgery. Thirty-day mortality was predicted from suPAR, hsCRP, and EuroSCORE II by logistic regression and compared using area under the receiver operating characteristics curve and Brier scores. After adjustment for known confounders, a doubling of suPAR and hsCRP corresponded to a hazard ratio for all-cause mortality of 2.27 (95% confidence interval 1.65-3.11; p < 0.001) and 1.26 (95% confidence interval 1.07-1.49; p = 0.005), respectively. However, adding the biomarkers to EuroSCORE II did not improve prediction/discrimination with respect to 30-day mortality.
Elevated preoperative levels of suPAR and hsCRP were associated with all-cause mortality in elective cardiac surgery patients. However, inclusion of biomarkers did not improve the prognostic accuracy of EuroSCORE II.
升高的可溶性尿激酶型纤溶酶原激活物受体（suPAR）和高敏 C 反应蛋白（hsCRP）与心血管疾病患者的死亡率增加有关。本研究的目的是探讨择期心脏手术后 suPAR 和 hsCRP 值与死亡率之间的关系。次要目的是评估欧洲心脏手术风险评估系统（EuroSCORE II）、suPAR 和/或 hsCRP 的联合风险模型是否比单独使用 EuroSCORE II 能提高预后准确性。
回顾性观察性研究。
单中心、大学医院。
纳入接受择期体外循环心脏手术的成年患者。生物库血液样本来自 2012 年至 2018 年一个三级心脏中心的先前研究项目。
无。
共纳入 931 例患者。采用 Kaplan-Meier 和 Cox 比例风险分析探讨术前 suPAR 和 hsCRP 值与术后 1 年内全因死亡率之间的潜在关联。通过逻辑回归预测 suPAR、hsCRP 和 EuroSCORE II 对 30 天死亡率的预测，并通过接收者操作特征曲线下面积和 Brier 评分进行比较。在调整了已知混杂因素后，suPAR 和 hsCRP 加倍与全因死亡率的风险比分别为 2.27（95%置信区间 1.65-3.11；p < 0.001）和 1.26（95%置信区间 1.07-1.49；p = 0.005）。然而，将生物标志物添加到 EuroSCORE II 中并没有提高 30 天死亡率的预测/区分能力。
升高的术前 suPAR 和 hsCRP 水平与择期心脏手术患者的全因死亡率相关。然而，纳入生物标志物并没有提高 EuroSCORE II 的预后准确性。
