Turan Alparslan, Rivas Eva, Devereaux P J, Pu Xuan, Rodriguez-Patarroyo Fabio A, Yalcin Esra Kutlu, Nault Rod, Maheshwari Kamal, Ruetzler Kurt, Sessler Daniel I
From the Department of Outcomes Research (AT, ER, XP, FAR-P, EKY, KM, KR, DIS), Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA (AT, KM, KR), Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Spain (ER), Population Health Research Institute, Hamilton Health Sciences and McMaster University, and the Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada (PJD), Department of Quantitative Health Sciences (XP) and Learner Medical School, Cleveland Clinic, Cleveland, Ohio, USA (RN).
Eur J Anaesthesiol. 2023 May 1;40(5):365-371. doi: 10.1097/EJA.0000000000001816. Epub 2023 Mar 9.
Hypotension and postoperative anaemia are associated with myocardial and renal injury after noncardiac surgery, but the interaction between them remains unknown.
To test the hypothesis that a double-hit of postoperative anaemia and hypotension synergistically worsens a 30-day composite of myocardial infarction (MI) and mortality and acute kidney injury (AKI). Characterising the interaction when hypotension and anaemia occur at same time on myocardial infarction and acute kidney injury.
Post hoc analysis of the POISE-2 trial.
Patients were enrolled between July 2010 and December 2013 at 135 hospitals in 23 countries.
Adults at least 45 years old with known or suspected cardiovascular disease. We excluded patients without available postoperative haemoglobin measurements or hypotension duration records. Exposures were the lowest haemoglobin concentration and the average daily duration of SBP less than 90 mmHg within the first four postoperative days.
The primary outcome was a collapsed composite of nonfatal MI and all-cause mortality during the initial 30 postoperative days; our secondary outcome was AKI.
We included 7940 patients. The mean ± SD lowest postoperative haemoglobin was 10 ± 2 g dl -1 , and 24% of the patients had SBP less than 90 mmHg with daily duration ranging from 0 to 15 h. Four hundred and nine (5.2%) patients had an infarction or died within 30 postoperative days, and 417 (6.4%) patients developed AKI. Lowest haemoglobin concentrations less than 11 g dl -1 , and duration of SBP less than 90 mmHg was associated with greater hazard of composite outcome of nonfatal MI and all-cause mortality, as well as with AKI. However, we did not find significant multiplicative interactions between haemoglobin splines and hypotension duration on the primary composite or on AKI.
Postoperative anaemia and hypotension were meaningfully associated with both our primary composite and AKI. However, lack of significant interaction suggests that the effects of hypotension and anaemia are additive rather than multiplicative.
Clinicaltrials.gov: NCT01082874.
低血压和术后贫血与非心脏手术后的心肌和肾脏损伤相关，但它们之间的相互作用尚不清楚。
检验术后贫血和低血压的双重打击会协同加重心肌梗死（MI）、死亡率和急性肾损伤（AKI）的30天综合指标这一假设。描述低血压和贫血同时发生时对心肌梗死和急性肾损伤的相互作用。
POISE-2试验的事后分析。
2010年7月至2013年12月期间，在23个国家的135家医院招募患者。
年龄至少45岁的已知或疑似心血管疾病的成年人。我们排除了没有术后血红蛋白测量值或低血压持续时间记录的患者。暴露因素为术后前四天内最低血红蛋白浓度和收缩压低于90mmHg的平均每日持续时间。
主要结局是术后最初30天内非致命性MI和全因死亡率的综合指标；次要结局是AKI。
我们纳入了7940名患者。术后最低血红蛋白平均值±标准差为10±2g·dl-1，24%的患者收缩压低于90mmHg，每日持续时间为0至15小时。409名（5.2%）患者在术后30天内发生梗死或死亡，417名（6.4%）患者发生AKI。最低血红蛋白浓度低于11g·dl-1以及收缩压低于90mmHg的持续时间与非致命性MI和全因死亡率的综合结局以及AKI的更大风险相关。然而，我们未发现血红蛋白样条与低血压持续时间在主要综合指标或AKI方面存在显著的相乘相互作用。
术后贫血和低血压与我们的主要综合指标和AKI均有显著关联。然而，缺乏显著相互作用表明低血压和贫血的影响是相加而非相乘的。
Clinicaltrials.gov：NCT01082874。
