术前降钙素原、C 反应蛋白和高敏 C 反应蛋白对老年非心脏手术后术后并发症风险的预测价值：巢式病例对照研究。
Predictive value of perioperative procalcitonin, C reactive protein and high-sensitivity C reactive protein for the risk of postoperative complications after non-cardiac surgery in elderly patients: a nested case-control study.
机构信息
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
BMJ Open. 2023 Oct 13;13(10):e071464. doi: 10.1136/bmjopen-2022-071464.
OBJECTIVE
Little is known about the correlation between perioperative concentrations of inflammatory biomarkers and postoperative complications. This study explored whether the plasma concentrations and perioperative changes of procalcitonin (PCT), C reactive protein (CRP) and high-sensitivity CRP (hsCRP) could predict the risk of postoperative morbidity in elderly patients undergoing elective non-cardiac surgery.
DESIGN
A nested case-control study.
SETTING
A tertiary hospital in China.
PARTICIPANTS
A total of 498 patients aged ≥65 years from a prospective cohort who underwent elective non-cardiac surgery between June 2020 and April 2021.
PRIMARY OUTCOME MEASURES
The primary outcomes were the efficacy of plasma concentrations of PCT, CRP and hsCRP in predicting the risk of Clavien-Dindo Classification (CDC) ≥grade 3 and major complications. The major complications included mortality, an intensive care unit stay length >24 hour, cardiovascular events, acute kidney injury, postoperative cognitive dysfunction and infections.
RESULTS
For major complications, the area under the curve (AUC) (95% CI) of PCT-24 hours, PCT change and PCT change rate were 0.750 (0.698 to 0.803), 0.740 (0.686 to 0.795) and 0.711 (0.651 to 0.771), respectively. The AUC (95% CI) of CRP-24 hours, CRP change, CRP change rate and hsCRP baseline were 0.835 (0.789 to 0.881), 0.818 (0.770 to 0.867), 0.691 (0.625 to 0.756) and 0.616 (0.554 to 0.678), respectively. For complications ≥CDC grade 3, the AUC (95% CI) of PCT-24 hours, PCT change and PCT change rate were 0.662 (0.543 to 0.780), 0.643 (0.514 to 0.772) and 0.627 (0.494 to 0.761), respectively. The AUC (95% CI) of CRP-24 hours and hsCRP baseline were 0.649 (0.527 to 0.771) and 0.639 (0.530 to 0.748), respectively.
CONCLUSIONS
PCT-24 hours, CRP-24 hours, the change of perioperative PCT and CRP were valuable predictors of major complications occurring within 30 days after non-cardiac surgery in the elderly.
TRIAL REGISTRATION NUMBER
China Clinical Trial Registry: ChiCTR1900026223.
目的
关于围手术期炎症生物标志物浓度与术后并发症之间的相关性，目前所知甚少。本研究旨在探讨降钙素原（PCT）、C 反应蛋白（CRP）和高敏 C 反应蛋白（hsCRP）的血浆浓度及其围手术期变化是否可预测行择期非心脏手术的老年患者术后发病风险。
设计
巢式病例对照研究。
地点
中国一家三级医院。
参与者
2020 年 6 月至 2021 年 4 月期间，来自前瞻性队列的 498 名年龄≥65 岁、行择期非心脏手术的患者。
主要结局指标
主要结局是 PCT、CRP 和 hsCRP 血浆浓度预测 Clavien-Dindo 分类（CDC）≥3 级和主要并发症风险的效果。主要并发症包括死亡率、重症监护病房停留时间＞24 小时、心血管事件、急性肾损伤、术后认知功能障碍和感染。
结果
对于主要并发症，PCT-24 小时、PCT 变化和 PCT 变化率的曲线下面积（95%CI）分别为 0.750（0.698 至 0.803）、0.740（0.686 至 0.795）和 0.711（0.651 至 0.771）。PCT-24 小时、CRP 变化、CRP 变化率和 hsCRP 基线的曲线下面积（95%CI）分别为 0.835（0.789 至 0.881）、0.818（0.770 至 0.867）、0.691（0.625 至 0.756）和 0.616（0.554 至 0.678）。对于≥CDC 分级 3 的并发症，PCT-24 小时、PCT 变化和 PCT 变化率的曲线下面积（95%CI）分别为 0.662（0.543 至 0.780）、0.643（0.514 至 0.772）和 0.627（0.494 至 0.761）。PCT-24 小时和 hsCRP 基线的曲线下面积（95%CI）分别为 0.649（0.527 至 0.771）和 0.639（0.530 至 0.748）。
结论
PCT-24 小时、CRP-24 小时、围手术期 PCT 变化和 CRP 变化是老年患者非心脏手术后 30 天内发生主要并发症的有价值的预测指标。
试验注册
中国临床试验注册中心：ChiCTR1900026223。
Zotero 插件