术前生长分化因子 15 浓度与非心脏大手术后术后心血管事件的相关性。

Association of Preoperative Growth Differentiation Factor-15 Concentrations and Postoperative Cardiovascular Events after Major Noncardiac Surgery.

机构信息

Department of Medicine, University of Montreal, Montreal, Canada; Population Health Research Institute, Hamilton, Canada.

Population Health Research Institute, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, and Department of Medicine, McMaster University, Hamilton, Canada.

出版信息

Anesthesiology. 2023 May 1;138(5):508-522. doi: 10.1097/ALN.0000000000004539.

DOI:10.1097/ALN.0000000000004539

PMID:37039711

Abstract

BACKGROUND

The association between growth differentiation factor-15 concentrations and cardiovascular disease has been well described. The study hypothesis was that growth differentiation factor-15 may help cardiac risk stratification in noncardiac surgical patients, in addition to clinical evaluation.

METHODS

The objective of the study was to determine whether preoperative serum growth differentiation factor-15 is associated with the composite primary outcome of myocardial injury after noncardiac surgery and vascular death at 30 days and can improve cardiac risk prediction in noncardiac surgery. This is a prospective cohort study of patients 45 yr or older having major noncardiac surgery. The association between preoperative growth differentiation factor-15 and the primary outcome was determined after adjusting for the Revised Cardiac Risk Index. Preoperative N-terminal-pro hormone brain natriuretic peptide was also added to compare predictive performance with growth differentiation factor-15.

RESULTS

Between October 27, 2008, and October 30, 2013, a total of 5,238 patients were included who had preoperative growth differentiation factor-15 measured (median, 1,325; interquartile range, 880 to 2,132 pg/ml). The risk of myocardial injury after noncardiac surgery and vascular death was 99 of 1,705 (5.8%) for growth differentiation factor-15 less than 1,000 pg/ml, 161 of 1,332 (12.1%) for growth differentiation factor-15 1,000 to less than 1,500 pg/ml, 302 of 1476 (20.5%) for growth differentiation factor-15 1,500 to less than 3,000 pg/ml, and 247 of 725 (34.1%) for growth differentiation factor-15 concentrations 3,000 pg/ml or greater. Compared to patients who had growth differentiation factor-15 concentrations less than 1,000 pg/ml, the corresponding adjusted hazard ratio for each growth differentiation factor-15 category was 1.93 (95% CI, 1.50 to 2.48), 3.04 (95% CI, 2.41 to 3.84), and 4.8 (95% CI, 3.76 to 6.14), respectively. The addition of growth differentiation factor-15 improved cardiac risk classification by 30.1% (301 per 1,000 patients) compared to Revised Cardiac Risk Index alone. It also provided additional risk classification beyond the combination of preoperative N-terminal-pro hormone brain natriuretic peptide and Revised Cardiac Risk Index (16.1%; 161 per 1,000 patients).

CONCLUSIONS

Growth differentiation factor-15 is strongly associated with 30-day risk of major cardiovascular events and significantly improved cardiac risk prediction in patients undergoing noncardiac surgery.

摘要

背景

生长分化因子-15 浓度与心血管疾病之间的关联已得到充分描述。研究假设是，生长分化因子-15 除了临床评估外，还可能有助于非心脏手术患者的心脏风险分层。

方法

本研究的目的是确定术前血清生长分化因子-15 是否与非心脏手术后心肌损伤和 30 天血管死亡的复合主要结局相关，并可改善非心脏手术的心脏风险预测。这是一项对 45 岁或以上行重大非心脏手术的患者进行的前瞻性队列研究。在调整修订后的心脏风险指数后，确定了术前生长分化因子-15 与主要结局之间的关联。还添加了术前 N 末端前脑钠肽以比较与生长分化因子-15 的预测性能。

结果

2008 年 10 月 27 日至 2013 年 10 月 30 日，共纳入 5238 例接受术前生长分化因子-15 检测的患者（中位数 1325pg/ml；四分位距 880 至 2132pg/ml）。非心脏手术后心肌损伤和血管死亡的风险为生长分化因子-15<1000pg/ml 的 1705 例中有 99 例（5.8%），生长分化因子-15 为 1000 至<1500pg/ml 的 1332 例中有 161 例（12.1%），生长分化因子-15 为 1500 至<3000pg/ml 的 1476 例中有 302 例（20.5%），生长分化因子-15 浓度为 3000pg/ml 或更高的 725 例中有 247 例（34.1%）。与生长分化因子-15<1000pg/ml 的患者相比，每个生长分化因子-15 类别的相应调整后的危险比分别为 1.93（95%CI 1.50 至 2.48），3.04（95%CI 2.41 至 3.84）和 4.8（95%CI 3.76 至 6.14）。与单独使用修订后的心脏风险指数相比，生长分化因子-15 的添加使心脏风险分类提高了 30.1%（每 1000 例患者中有 301 例）。与术前 N 末端前脑钠肽和修订后的心脏风险指数相结合，它还提供了额外的风险分类（16.1%；每 1000 例患者中有 161 例）。