Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada; Population Health Research Institute, 20 Copeland Ave, Hamilton, Ontario L8L 2X2, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada.
Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada.
J Clin Anesth. 2024 Oct;97:111540. doi: 10.1016/j.jclinane.2024.111540. Epub 2024 Jul 2.
Noncardiac surgery is associated with an inflammatory response. Whether increased inflammation in the perioperative period is associated with subsequent morbidity and mortality is unknown.
MEDLINE, EMBASE, and CENTRAL were systematically searched from date of inception until May 2023. Longitudinal studies were included if they reported multivariable adjusted associations of biomarkers measured preoperatively and/or within 10 days after surgery with at least one prespecified adverse outcome in noncardiac surgery patients. Data were extracted independently and in duplicate. Risk estimates were pooled using DerSimonian-Laird random-effects models and reported as summary odds ratios (ORs) with 95% CIs. The outcomes were all-cause mortality and major adverse cardiovascular events.
Fifty-two studies with a total of 121,849 patients were included. The median follow-up was 56 [IQR, 28-63] months and the average age was 57 (±3) years. Elevated preoperative C-reactive protein (CRP) levels were associated with a higher risk of mortality (OR 1.57, 95% CI 1.29-1.90, I = 93%, 28 studies). This association was stronger in non-cancer surgery populations (OR 2.10, 95% CI 1.92-2.31, I = 0%, 4 studies) when compared to cancer surgery populations (OR 1.51, 95% CI 1.26-1.81, I = 83%, 24 studies) (p for subgroup difference = 0.001). Similarly, higher postoperative CRP levels were associated with all-cause mortality (OR 1.61, 95% CI 1.17-2.20, I = 90%, 7 studies). Higher preoperative CRP levels were associated with major cardiovascular events (OR 2.11, 95% CI 1.51-2.94, I = 0%, 2 studies). Other preoperatively measured biomarkers associated with all-cause mortality were fibrinogen (OR 1.48, 95% CI 1.05-2.09, I = 52%, 5 studies), interleukin-6 (OR 1.17, 95% CI 1.07-1.28, I = 27%, 3 studies), and tumour necrosis factor-alpha (OR 1.37, 95% CI 1.16-1.61, I = 0%, 2 studies).
Inflammatory biomarker levels in the perioperative period were associated with all-cause mortality and adverse cardiovascular events in patients undergoing noncardiac surgery.
非心脏手术会引起炎症反应。围手术期炎症增加是否与随后的发病率和死亡率有关尚不清楚。
从成立日期到 2023 年 5 月，系统地检索了 MEDLINE、EMBASE 和 CENTRAL。如果研究报告了术前和/或手术后 10 天内测量的生物标志物与非心脏手术患者的至少一个预先指定的不良结局之间的多变量调整关联，则纳入纵向研究。数据由两名独立人员提取。使用 DerSimonian-Laird 随机效应模型汇总风险估计，并以汇总优势比 (OR) 及其 95%置信区间 (CI) 报告。结局为全因死亡率和主要不良心血管事件。
共纳入 52 项研究，总计 121849 名患者。中位随访时间为 56（IQR，28-63）个月，平均年龄为 57（±3）岁。术前 C 反应蛋白（CRP）水平升高与死亡率升高相关（OR 1.57，95%CI 1.29-1.90，I=93%，28 项研究）。与癌症手术人群（OR 1.51，95%CI 1.26-1.81，I=83%，24 项研究）相比，这种关联在非癌症手术人群（OR 2.10，95%CI 1.92-2.31，I=0%，4 项研究）中更强（亚组差异的 p 值=0.001）。同样，较高的术后 CRP 水平与全因死亡率相关（OR 1.61，95%CI 1.17-2.20，I=90%，7 项研究）。术前较高的 CRP 水平与主要心血管事件相关（OR 2.11，95%CI 1.51-2.94，I=0%，2 项研究）。与全因死亡率相关的其他术前测量的生物标志物还有纤维蛋白原（OR 1.48，95%CI 1.05-2.09，I=52%，5 项研究）、白细胞介素-6（OR 1.17，95%CI 1.07-1.28，I=27%，3 项研究）和肿瘤坏死因子-α（OR 1.37，95%CI 1.16-1.61，I=0%，2 项研究）。
围手术期炎症生物标志物水平与非心脏手术患者的全因死亡率和不良心血管事件有关。
