Association between troponin I levels and mortality among patients undergoing acute high-risk abdominal surgery-A cohort study
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Association between troponin I levels and mortality among patients undergoing acute high-risk abdominal surgery-A cohort study. / Kanstrup, Charlotte Tiffanie Bendtz; Serup, Camilla Mattesen; Svarre, Kristina Johansen; Rasmussen, Maja Christine; Lundstrøm, Lars Hyldborg; Kleif, Jakob; Bertelsen, Claus Anders.
I: World Journal of Surgery, Bind 48, Nr. 2, 2024, s. 361-370.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Association between troponin I levels and mortality among patients undergoing acute high-risk abdominal surgery-A cohort study
AU - Kanstrup, Charlotte Tiffanie Bendtz
AU - Serup, Camilla Mattesen
AU - Svarre, Kristina Johansen
AU - Rasmussen, Maja Christine
AU - Lundstrøm, Lars Hyldborg
AU - Kleif, Jakob
AU - Bertelsen, Claus Anders
N1 - Publisher Copyright: © 2024 The Authors. World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).
PY - 2024
Y1 - 2024
N2 - BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is associated with 30-day mortality in heterogeneous surgical populations but is barely described after acute high-risk abdominal surgery. The impact of dynamic changes has not previously been investigated. The objectives were to determine the incidence of MINS in this population, the association between mortality and MINS, and whether plasma troponin I (TnI) dynamics have any impact on mortality. METHODS: A prospective cohort study of 341 patients undergoing acute high-risk gastrointestinal surgery was conducted. Plasma TnI was measured at the first four postoperative days. MINS was defined as any increased TnI level >59 ng/L. TnI dynamic required either two succeeding measurements of TnI >59 ng/L with a >20% increase/fall or one measurement of TnI >59 ng/L with a succeeding measurement of TnI <59 ng/L with a >50% decrease. Adjusted mortality rates were calculated using inverse probability of treatment weighting and competing risk analyses. RESULTS: The incidence of MINS was 23.8% and dynamic TnI changes occurred in 15.6% of the patients. The unadjusted 30-day and 1-year mortality were 19.8% and 35.9% in patients with MINS, compared with 2.7% and 11.6%, respectively, in patients without MINS (p < 0.001). After adjusting, the differences remained significant. There was no difference in mortality between patients with or without dynamic changes in TnI level. CONCLUSION: MINS occurred frequently and was associated with increased mortality. TnI monitoring might help identify patients with increased risk of mortality and improve care. Research on preventive measures and treatments is warranted. TRIAL REGISTRATION NUMBER AND AGENCY: ClinicalTrials.gov Identifier: NCT05933837, retrospective registered.
AB - BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is associated with 30-day mortality in heterogeneous surgical populations but is barely described after acute high-risk abdominal surgery. The impact of dynamic changes has not previously been investigated. The objectives were to determine the incidence of MINS in this population, the association between mortality and MINS, and whether plasma troponin I (TnI) dynamics have any impact on mortality. METHODS: A prospective cohort study of 341 patients undergoing acute high-risk gastrointestinal surgery was conducted. Plasma TnI was measured at the first four postoperative days. MINS was defined as any increased TnI level >59 ng/L. TnI dynamic required either two succeeding measurements of TnI >59 ng/L with a >20% increase/fall or one measurement of TnI >59 ng/L with a succeeding measurement of TnI <59 ng/L with a >50% decrease. Adjusted mortality rates were calculated using inverse probability of treatment weighting and competing risk analyses. RESULTS: The incidence of MINS was 23.8% and dynamic TnI changes occurred in 15.6% of the patients. The unadjusted 30-day and 1-year mortality were 19.8% and 35.9% in patients with MINS, compared with 2.7% and 11.6%, respectively, in patients without MINS (p < 0.001). After adjusting, the differences remained significant. There was no difference in mortality between patients with or without dynamic changes in TnI level. CONCLUSION: MINS occurred frequently and was associated with increased mortality. TnI monitoring might help identify patients with increased risk of mortality and improve care. Research on preventive measures and treatments is warranted. TRIAL REGISTRATION NUMBER AND AGENCY: ClinicalTrials.gov Identifier: NCT05933837, retrospective registered.
KW - cardiac
KW - colorectal
KW - critical care
KW - gastrointestinal
KW - outcomes
U2 - 10.1002/wjs.12035
DO - 10.1002/wjs.12035
M3 - Journal article
C2 - 38284768
AN - SCOPUS:85184284555
VL - 48
SP - 361
EP - 370
JO - World Journal of Surgery
JF - World Journal of Surgery
SN - 0364-2313
IS - 2
ER -
ID: 382978315