High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery

P G Noordzij; O van Geffen; I M Dijkstra; D Boerma; A J Meinders; T C D Rettig; F D Eefting; D van Loon; E M W van de Garde; E P A van Dongen

doi:10.1093/bja/aev027

High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery

P G Noordzij^*, O van Geffen, I M Dijkstra, D Boerma, A J Meinders, T C D Rettig, F D Eefting, D van Loon, E M W van de Garde, E P A van Dongen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the relationship between postoperative high-sensitive cardiac troponin T elevations and non-cardiac complications in patients after major abdominal surgery.

METHODS: This prospective observational single-centre cohort study included patients at risk for coronary artery disease undergoing elective major abdominal surgery. Cardiac troponin was measured before surgery and at day 1, 3, and 7. Multivariable logistic regression analysis was performed to examine the adjusted association for different cut-off concentrations of postoperative myocardial injury and non-cardiac outcome.

RESULTS: In 203 patients, 690 high-sensitive cardiac troponin T measurements were performed. Fifty-three patients (26%) had a non-cardiac complication within 30 days after surgery. Hospital mortality was 4% (8/203). An increase in cardiac troponin T concentration ≥100% compared with baseline was a superior independent predictor of non-cardiac postoperative clinical complications (adjusted odds ratio 4.3, 95% confidence interval 1.8-10.1, P<0.001) and was associated with increased length of stay (9 days, 95% confidence interval 7-11 vs 7 days, 95% confidence interval 6-8, P=0.004) and increased hospital mortality (12 vs 2%, P=0.028).

CONCLUSIONS: A postoperative high-sensitive cardiac troponin T increase ≥100% is a strong predictor of non-cardiac 30 day complications, increased hospital stay and hospital mortality in patients undergoing major abdominal surgery.

CLINICALTRIALSGOV IDENTIFIER: NCT02150486.

Original language	English
Pages (from-to)	909-918
Number of pages	10
Journal	British Journal of Anaesthesia
Volume	114
Issue number	6
DOIs	https://doi.org/10.1093/bja/aev027
Publication status	Published - Jun 2015
Externally published	Yes

Keywords

Abdomen/surgery
Aged
Cohort Studies
Endpoint Determination
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Myocardium/metabolism
Odds Ratio
Postoperative Complications/blood
Predictive Value of Tests
Prospective Studies
Troponin T/metabolism

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10.1093/bja/aev027

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Noordzij, P. G., van Geffen, O., Dijkstra, I. M., Boerma, D., Meinders, A. J., Rettig, T. C. D., Eefting, F. D., van Loon, D., van de Garde, E. M. W., & van Dongen, E. P. A. (2015). High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery. British Journal of Anaesthesia, 114(6), 909-918. https://doi.org/10.1093/bja/aev027

@article{fb86089710b346a4ac5945e08939194b,

title = "High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery",

abstract = "BACKGROUND: Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the relationship between postoperative high-sensitive cardiac troponin T elevations and non-cardiac complications in patients after major abdominal surgery.METHODS: This prospective observational single-centre cohort study included patients at risk for coronary artery disease undergoing elective major abdominal surgery. Cardiac troponin was measured before surgery and at day 1, 3, and 7. Multivariable logistic regression analysis was performed to examine the adjusted association for different cut-off concentrations of postoperative myocardial injury and non-cardiac outcome.RESULTS: In 203 patients, 690 high-sensitive cardiac troponin T measurements were performed. Fifty-three patients (26%) had a non-cardiac complication within 30 days after surgery. Hospital mortality was 4% (8/203). An increase in cardiac troponin T concentration ≥100% compared with baseline was a superior independent predictor of non-cardiac postoperative clinical complications (adjusted odds ratio 4.3, 95% confidence interval 1.8-10.1, P<0.001) and was associated with increased length of stay (9 days, 95% confidence interval 7-11 vs 7 days, 95% confidence interval 6-8, P=0.004) and increased hospital mortality (12 vs 2%, P=0.028).CONCLUSIONS: A postoperative high-sensitive cardiac troponin T increase ≥100% is a strong predictor of non-cardiac 30 day complications, increased hospital stay and hospital mortality in patients undergoing major abdominal surgery.CLINICALTRIALSGOV IDENTIFIER: NCT02150486.",

keywords = "Abdomen/surgery, Aged, Cohort Studies, Endpoint Determination, Female, Hospital Mortality, Humans, Length of Stay, Male, Middle Aged, Myocardium/metabolism, Odds Ratio, Postoperative Complications/blood, Predictive Value of Tests, Prospective Studies, Troponin T/metabolism",

author = "Noordzij, {P G} and {van Geffen}, O and Dijkstra, {I M} and D Boerma and Meinders, {A J} and Rettig, {T C D} and Eefting, {F D} and {van Loon}, D and {van de Garde}, {E M W} and {van Dongen}, {E P A}",

year = "2015",

month = jun,

doi = "10.1093/bja/aev027",

language = "English",

volume = "114",

pages = "909--918",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Oxford University Press",

number = "6",

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TY - JOUR

T1 - High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery

AU - Noordzij, P G

AU - van Geffen, O

AU - Dijkstra, I M

AU - Boerma, D

AU - Meinders, A J

AU - Rettig, T C D

AU - Eefting, F D

AU - van Loon, D

AU - van de Garde, E M W

AU - van Dongen, E P A

PY - 2015/6

Y1 - 2015/6

N2 - BACKGROUND: Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the relationship between postoperative high-sensitive cardiac troponin T elevations and non-cardiac complications in patients after major abdominal surgery.METHODS: This prospective observational single-centre cohort study included patients at risk for coronary artery disease undergoing elective major abdominal surgery. Cardiac troponin was measured before surgery and at day 1, 3, and 7. Multivariable logistic regression analysis was performed to examine the adjusted association for different cut-off concentrations of postoperative myocardial injury and non-cardiac outcome.RESULTS: In 203 patients, 690 high-sensitive cardiac troponin T measurements were performed. Fifty-three patients (26%) had a non-cardiac complication within 30 days after surgery. Hospital mortality was 4% (8/203). An increase in cardiac troponin T concentration ≥100% compared with baseline was a superior independent predictor of non-cardiac postoperative clinical complications (adjusted odds ratio 4.3, 95% confidence interval 1.8-10.1, P<0.001) and was associated with increased length of stay (9 days, 95% confidence interval 7-11 vs 7 days, 95% confidence interval 6-8, P=0.004) and increased hospital mortality (12 vs 2%, P=0.028).CONCLUSIONS: A postoperative high-sensitive cardiac troponin T increase ≥100% is a strong predictor of non-cardiac 30 day complications, increased hospital stay and hospital mortality in patients undergoing major abdominal surgery.CLINICALTRIALSGOV IDENTIFIER: NCT02150486.

AB - BACKGROUND: Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the relationship between postoperative high-sensitive cardiac troponin T elevations and non-cardiac complications in patients after major abdominal surgery.METHODS: This prospective observational single-centre cohort study included patients at risk for coronary artery disease undergoing elective major abdominal surgery. Cardiac troponin was measured before surgery and at day 1, 3, and 7. Multivariable logistic regression analysis was performed to examine the adjusted association for different cut-off concentrations of postoperative myocardial injury and non-cardiac outcome.RESULTS: In 203 patients, 690 high-sensitive cardiac troponin T measurements were performed. Fifty-three patients (26%) had a non-cardiac complication within 30 days after surgery. Hospital mortality was 4% (8/203). An increase in cardiac troponin T concentration ≥100% compared with baseline was a superior independent predictor of non-cardiac postoperative clinical complications (adjusted odds ratio 4.3, 95% confidence interval 1.8-10.1, P<0.001) and was associated with increased length of stay (9 days, 95% confidence interval 7-11 vs 7 days, 95% confidence interval 6-8, P=0.004) and increased hospital mortality (12 vs 2%, P=0.028).CONCLUSIONS: A postoperative high-sensitive cardiac troponin T increase ≥100% is a strong predictor of non-cardiac 30 day complications, increased hospital stay and hospital mortality in patients undergoing major abdominal surgery.CLINICALTRIALSGOV IDENTIFIER: NCT02150486.

KW - Abdomen/surgery

KW - Aged

KW - Cohort Studies

KW - Endpoint Determination

KW - Female

KW - Hospital Mortality

KW - Humans

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - Myocardium/metabolism

KW - Odds Ratio

KW - Postoperative Complications/blood

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Troponin T/metabolism

U2 - 10.1093/bja/aev027

DO - 10.1093/bja/aev027

M3 - Article

C2 - 25740400

SN - 0007-0912

VL - 114

SP - 909

EP - 918

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 6

ER -

High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery

Abstract

Keywords

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