Li Qian, Lv Hong, Chen Yuye, Shen Jingjia, Shi Jia, Zhou Chenghui
Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiology. 2025;150(3):311-319. doi: 10.1159/000541213. Epub 2024 Sep 16.
We sought to comprehensively explore the potential linear and nonlinear relationship between preoperative iron metabolism and perioperative myocardial injury (PMI) following cardiac surgery with cardiopulmonary bypass (CPB).
Patients who underwent cardiac surgery with CPB between December 2018 and April 2021 were retrospectively collected. The measurements of iron metabolism included serum iron (SI), serum ferritin (SF), transferrin (TRF), transferrin saturation (TS), and total iron-binding capacity (TIBC). Logistic regression and restricted cubic spline (RCS) models were used for linear and nonlinear analysis. The primary outcome was PMI with a 100× upper reference limit.
Of 2,420 patients screened, 744 eligible patients were enrolled for the final analysis. The incidence of PMI was 25.7%. No significant linear relationship was observed. In the RCS models adjusted with age (median: 56), female, and history of diabetes, a statistically significant difference was detected between TRF (p for nonlinear 0.0152) or TIBC (p for nonlinear 0.0477) and PMI. The gentle U-shaped relationship observed between TRF, TIBC, and PMI suggests that when TRF and TIBC increase, the risk decreases, reaching its lowest point when TRF = 2.4 and TIBC = 54. Nevertheless, as TRF and TIBC continue to increase, the risk starts to rise again. Subgroup analyses yielded consistent findings, with a notable emphasis on older patients who were more susceptible to variations in iron metabolism.
Iron metabolism, including TRF, and TIBC, exhibited a nonlinear relationship with PMI by the RCS model adjusted by age, gender, and history of diabetes.
我们试图全面探讨术前铁代谢与体外循环心脏手术后围手术期心肌损伤（PMI）之间潜在的线性和非线性关系。
回顾性收集2018年12月至2021年4月期间接受体外循环心脏手术的患者。铁代谢指标包括血清铁（SI）、血清铁蛋白（SF）、转铁蛋白（TRF）、转铁蛋白饱和度（TS）和总铁结合力（TIBC）。采用逻辑回归和受限立方样条（RCS）模型进行线性和非线性分析。主要结局为PMI且超过参考上限100倍。
在筛查的2420例患者中，744例符合条件的患者纳入最终分析。PMI的发生率为25.7%。未观察到显著的线性关系。在根据年龄（中位数：56岁）、女性和糖尿病病史进行调整的RCS模型中，检测到TRF（非线性p值为0.0152）或TIBC（非线性p值为0.0477）与PMI之间存在统计学显著差异。TRF、TIBC与PMI之间观察到的平缓U形关系表明，当TRF和TIBC升高时，风险降低，当TRF = 2.4且TIBC = 54时达到最低点。然而，随着TRF和TIBC继续升高，风险又开始上升。亚组分析得出了一致的结果，特别强调老年患者更容易受到铁代谢变化的影响。
通过根据年龄、性别和糖尿病病史调整的RCS模型，包括TRF和TIBC在内的铁代谢与PMI呈现非线性关系。
