Imperiali Claudia E, Lopez-Delgado Juan C, Dastis-Arias Macarena, Sanchez-Navarro Lourdes
Clinical Laboratory, Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain.
Biochemistry and Molecular Biology Department, Universitat Autonoma de Barcelona, Barcelona, Spain.
Adv Lab Med. 2020 Jul 27;1(4):20200031. doi: 10.1515/almed-2020-0031. eCollection 2020 Dec.
The postoperative period of cardiac surgery (CS) is associated with the development of major adverse cardiovascular events (MACEs). However, the evaluation of MACE after CS by means of biomarkers is poorly developed. We aimed to evaluate postoperative biomarkers that could be associated with MACE.
Two Hundred and ten patients who underwent CS were enrolled during the study period. The diagnosis of MACE was defined as the presence of at least one of the following complications: acute myocardial infarction, heart failure, stroke presented during intensive care unit (ICU) stay, and 30-day mortality after CS. High-sensitive troponin T (hs-TnT), C-reactive protein, procalcitonin, interleukin-6, and immature platelet fraction (IPF) were measured on ICU admission and after 24 h. The difference between both measurements (Δ) was calculated to assess their association with MACE. Early infected patients (n=13) after CS were excluded from final analysis.
The most frequent surgery was single-valve surgery (n=83; 38%), followed by coronary artery bypass graft (n=72; 34%). Postoperative MACE was diagnosed in 31 (14.8%) patients. Biomarker dynamics showed elevated values at 24 h compared with those at ICU admission in patients with MACE versus no-MACE. Multivariate analysis showed that ΔIPF (OR: 1.47; 95% CI: 1.110-1.960; p=0.008) and Δhs-TnT (OR: 1.001; 95% CI: 1.0002-1.001; p=0.008) were independently associated with MACE.
These findings suggest that postoperative ΔIPF and Δhs-TnT may be useful biomarkers for the identification of patients at risk of MACE development.
心脏手术（CS）术后阶段与主要不良心血管事件（MACE）的发生相关。然而，通过生物标志物评估CS后的MACE进展情况的研究尚不完善。我们旨在评估可能与MACE相关的术后生物标志物。
在研究期间纳入了210例行CS的患者。MACE的诊断定义为出现以下至少一种并发症：急性心肌梗死、心力衰竭、重症监护病房（ICU）住院期间发生的中风以及CS后30天死亡率。在入住ICU时和24小时后测量高敏肌钙蛋白T（hs-TnT）、C反应蛋白、降钙素原、白细胞介素-6和未成熟血小板分数（IPF）。计算两次测量值之间的差值（Δ）以评估它们与MACE的相关性。CS术后早期感染患者（n = 13）被排除在最终分析之外。
最常见的手术是单瓣膜手术（n = 83；38%），其次是冠状动脉搭桥术（n = 72；34%）。31例（14.8%）患者被诊断为术后MACE。生物标志物动态变化显示，与无MACE的患者相比，发生MACE的患者在24小时时的数值高于入住ICU时。多因素分析显示，ΔIPF（比值比：1.47；95%置信区间：1.110 - 1.960；p = 0.008）和Δhs-TnT（比值比：1.001；95%置信区间：1.0002 - 1.001；p = 0.008）与MACE独立相关。
这些发现表明，术后ΔIPF和Δhs-TnT可能是用于识别有发生MACE风险患者的有用生物标志物。
