Early elevation in plasma high-sensitivity troponin T and morbidity after elective noncardiac surgery: prospective multicentre observational cohort study.

British Journal of Anaesthesia
Gareth AcklandLeeds Teaching Hospitals

Abstract

Elevated high-sensitivity troponin (hsTnT) after noncardiac surgery is associated with higher mortality, but the temporal relationship between early elevated troponin and the later development of noncardiac morbidity remains unclear. Prospective observational study of patients aged ≥45 yr undergoing major noncardiac surgery at four UK hospitals (two masked to hsTnT). The exposure of interest was early elevated troponin, as defined by hsTnT >99th centile (≥15 ng L-1) within 24 h after surgery. The primary outcome was morbidity 72 h after surgery, defined by the Postoperative Morbidity Survey (POMS). Secondary outcomes were time to become morbidity-free and Clavien-Dindo ≥grade 3 complications. Early elevated troponin (median 21 ng L-1 [16-32]) occurred in 992 of 4335 (22.9%) patients undergoing elective noncardiac surgery (mean [standard deviation, sd] age, 65 [11] yr; 2385 [54.9%] male). Noncardiac morbidity was more frequent in 494/992 (49.8%) patients with early elevated troponin compared with 1127/3343 (33.7%) patients with hsTnT <99th centile (odds ratio [OR]=1.95; 95% confidence interval [CI], 1.69-2.25). Patients with early elevated troponin had a higher risk of proven/suspected infectious morbidity (OR=1.54; 95% CI, 1.24...Continue Reading

References

Jul 30, 2009·Annals of Surgery·Pierre A Clavien, Steven M Strasberg
Dec 5, 2009·Clinical Chemistry·Evangelos GiannitsisHugo A Katus
Sep 3, 2010·Anesthesia and Analgesia·Gareth L AcklandMichael G Mythen
Sep 30, 2010·British Journal of Anaesthesia·G L AcklandUNKNOWN SOuRCe Investigators
Dec 20, 2014·The Lancet. Respiratory Medicine·Gareth L AcklandUNKNOWN POM-O (PostOperative Morbidity-Oxygen delivery) study group
Sep 2, 2015·British Journal of Anaesthesia·S KarmaliUNKNOWN POM-X Study Investigators
Apr 26, 2016·Anesthesia and Analgesia·Judith A R van WaesUNKNOWN Cardiac Health After Surgery (CHASE) Investigators
Apr 26, 2017·Intensive Care Medicine·Brennan C KahanUNKNOWN International Surgical Outcomes Study (ISOS) group
Apr 27, 2017·JAMA : the Journal of the American Medical Association·UNKNOWN Writing Committee for the VISION Study InvestigatorsGordon H Guyatt
Aug 5, 2017·Current Opinion in Critical Care·Sadia GhaffarMichael A Gillies
Dec 6, 2017·Circulation·Christian PuelacherUNKNOWN BASEL-PMI Investigators
Mar 14, 2018·Anesthesia and Analgesia·W Scott BeattieUNKNOWN ANZCA Clinical Trials Network for the ENIGMA-II Investigators
Nov 7, 2019·British Journal of Anaesthesia·Peter Nagele

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Citations

Oct 22, 2020·International Anesthesiology Clinics·Duminda N Wijeysundera
Jan 19, 2021·The Journal of Surgical Research·Segun LamidiMatthew J Lee
Jan 15, 2021·European Journal of Anaesthesiology·Tom E F AbbottUNKNOWN VISION-UK Investigators
May 4, 2021·Current Opinion in Anaesthesiology·Wojciech Szczeklik, Jakub Fronczek

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