Prognostic value of postoperative high-sensitivity troponin T in patients with different stages of kidney disease undergoing noncardiac surgery

Liem, Victor G B; Hoeks, Sanne E.; Grüne, Frank; Mol, Kristin H. J. M.; Wesdorp, F.H.I.M.; Stolker, Robert Jan; Lier, Felix van

doi:10.1016/j.bja.2017.09.003

Cited by 18 publications

(18 citation statements)

References 42 publications

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“…This single-center observational cohort study was derived from an ongoing clinical routine troponin registry of noncardiac surgery patients at the Erasmus University Medical Center, Rotterdam, The Netherlands. 12,18 Eligibility criteria were patients aged 60 yr or older undergoing intermediateto high-risk noncardiac surgery, including elective and emergency procedures with an expected postoperative length of hospitalization of at least 24 h. Patients were included in the period between July 1, 2012, and July 1, 2017. The sample size was based on the available data.…”

Section: Methodsmentioning

confidence: 99%

Postoperative Hypotension after Noncardiac Surgery and the Association with Myocardial Injury

Liem¹,

Hoeks²,

Mol³

et al. 2020

Anesthesiology

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Background Intraoperative hypotension has been associated with postoperative morbidity and early mortality. Postoperative hypotension, however, has been less studied. This study examines postoperative hypotension, hypothesizing that both the degree of hypotension severity and longer durations would be associated with myocardial injury. Methods This single-center observational cohort was comprised of 1,710 patients aged 60 yr or more undergoing intermediate- to high-risk noncardiac surgery. Frequent sampling of hemodynamic monitoring on a postoperative high-dependency ward during the first 24 h after surgery was recorded. Multiple mean arterial pressure (MAP) absolute thresholds (50 to 75 mmHg) were used to define hypotension characterized by cumulative minutes, duration, area, and time-weighted-average under MAP. Zero time spent under a threshold was used as the reference group. The primary outcome was myocardial injury (a peak high-sensitive troponin T measurement 50 ng/l or greater) during the first 3 postoperative days. Results Postoperative hypotension was common, e.g., 2 cumulative hours below a threshold of 60 mmHg occurred in 144 (8%) patients while 4 h less than 75 mmHg occurred in 824 (48%) patients. Patients with myocardial injury had higher prolonged exposures for all characterizations. After adjusting for confounders, postoperative duration below a threshold of 75 mmHg for more than 635 min was associated with myocardial injury (adjusted odds ratio, 2.68; 95% CI, 1.46 to 5.07, P = 0.002). Comparing multiple thresholds, cumulative durations of 2 to 4 h below a MAP threshold of 60 mmHg (adjusted odds ratio, 3.26; 95% CI, 1.57 to 6.48, P = 0.001) and durations of more than 4 h less than 65 mmHg (adjusted odds ratio, 2.98; 95% CI, 1.78 to 4.98, P < 0.001) and 70 mmHg (adjusted odds ratio, 2.18; 95% CI, 1.37 to 3.51, P < 0.001) were also associated with myocardial injury. Associations remained significant after adjusting for intraoperative hypotension, which independently was not associated with myocardial injury. Conclusions In this study, postoperative hypotension was common and was independently associated with myocardial injury. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Methodsmentioning

confidence: 99%

Postoperative Hypotension after Noncardiac Surgery and the Association with Myocardial Injury

Liem¹,

Hoeks²,

Mol³

et al. 2020

Anesthesiology

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“…The current study is nested within an observational cohort registry of patients aged at least 60 years undergoing intermediate-to-high risk noncardiac surgery at the Erasmus University Medical Centre, Rotterdam, the Netherlands between July 2012 and July 2015, who have been described previously. 1,11,12 This registry was reviewed by the Medical Ethical Committee of Erasmus University, Rotterdam, who approved the noninterventional character of the study (MEC-2013-397). The study was conducted in compliance with the Helsinki declaration 13 and strengthening the reporting of observational studies in epidemiology criteria 14 for observational studies.…”

Section: Study Design Setting and Participantsmentioning

confidence: 99%

“…For analysis, troponin levels were divided into four categories, as previously published. 1,11,12 The first category (<14 ng l À1 ) is considered normal, based on the manufacturer's 99th percentile of a normal population. 15 The second (14 to 49 ng l À1 ) was based on the 0.03 ng ml À1 threshold of the fourth-generation assay's abnormal elevations, which is equivalent to 50 ng l À1 of the fifth assay.…”

Section: Postoperative Troponin Measurementsmentioning

confidence: 99%

Immediate postoperative high-sensitivity troponin T concentrations and long-term patient-reported health-related quality of life

Mol

Lier

Liem

et al. 2020

European Journal of Anaesthesiology

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BACKGROUND Myocardial injury after noncardiac surgery is associated with mortality and major adverse postoperative cardiovascular events. The effect of postoperative troponin concentrations on patient-reported health-related quality of life (HRQoL) is unknown. OBJECTIVE The study examined the association between immediate postoperative troponin concentrations and selfreported HRQoL 1 year after surgery. DESIGN Prospective cohort study. SETTING Single-centre tertiary care hospital in the Netherlands between July 2012 and 2015. PATIENTS Patients aged at least 60 years undergoing moderate and major noncardiac surgery. INTERVENTION None. MAIN OUTCOME MEASURES HRQoL total score was assessed with the EuroQol five-dimensional questionnaire. Tobit regression analysis was used to determine the association between postoperative troponin concentrations and 1-year HRQoL. Peak high-sensitivity troponin T values were divided into four categories: less than 14, 14 to 49, 50 to 149 and at least 150 ng l À1. RESULTS A total of 3085 patients with troponin measurements were included. 2634 (85.4%) patients were alive at 1year follow-up of whom 1297 (49.2%) returned a completed questionnaire. The median score for HRQoL was 0.82 (0.85, 0.81, 0.77 and 0.71 per increasing troponin category). Multivariable analysis revealed betas of À0.06 [95% confidence interval (CI) À0.09 to À0.02], À0.11 (95% CI À0.18 to À0.04) and À0.18 (95% CI À0.29 to À0.07) for troponin levels of 14 to 49, 50 to 149 and at least 150 ng l À1 when compared with values less than 14 ng l À1. Other independent predictors for lower HRQoL were chronic obstructive pulmonary disease, female sex, peripheral arterial disease and increasing age. CONCLUSION Higher levels of postoperative troponin measured immediately after surgery were independently associated with lower self-reported HRQoL total score at 1-year follow-up.

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“…Between July 2012 and July 2015, all consecutive patients aged 60 years and older, undergoing intermediate-to-high risk noncardiac surgery at the Erasmus University Medical Center (Erasmus MC), were registered in an ongoing clinical routine troponin registry [9,10]. Intermediate-to-high risk noncardiac surgery included the following operations: major abdominal, genitourinary, vascular, orthopaedic and neurologic surgery [11].…”

Section: Patient Selectionmentioning

confidence: 99%

“…Myocardial injury was defined as a peak troponin elevation above the 99th percentile of 14 ng·L −1 in the first 3 days after surgery. For analysis, troponin levels were divided into four categories, as previously published [9,10]. The hsTnT thresholds were based on the manufacturers and previous determined postoperative prognostic values of the fourth generation assay [8].…”

Section: Postoperative Troponin Measurementsmentioning

confidence: 99%

Postoperative troponin release is associated with major adverse cardiovascular events in the first year after noncardiac surgery

Mol

Hoeks

Liem

et al. 2019

International Journal of Cardiology

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Prognostic value of postoperative high-sensitivity troponin T in patients with different stages of kidney disease undergoing noncardiac surgery

Abstract: Elevated postoperative hsTnT is associated with a dose-dependent increase in 30-day and long-term mortality risk in each stage of CKD with an estimated glomerular filtration rate ≥30 ml min 1.73 m.

Cited by 18 publications

References 42 publications

Postoperative Hypotension after Noncardiac Surgery and the Association with Myocardial Injury

Postoperative Hypotension after Noncardiac Surgery and the Association with Myocardial Injury

Immediate postoperative high-sensitivity troponin T concentrations and long-term patient-reported health-related quality of life

Postoperative troponin release is associated with major adverse cardiovascular events in the first year after noncardiac surgery

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