title: Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death.
abstract: Cardiac troponin T (cTnT), even at low concentrations, is a risk factor for 30-day mortality in patients undergoing noncardiac surgery, but it is uncertain whether that risk is generalizable to patients with poor kidney function. We, therefore, evaluated the relationship between cTnT concentration and kidney function on the outcome of 30-day mortality in a post hoc analysis of a prospective cohort study of patients undergoing noncardiac surgery. cTnT was measured for 3 days after surgery and considered abnormal if the peak was ≥0.02 ng/ml. Of the included 14,037 patients, 267 (1.9%) patients died within 30 days of surgery. The adjusted hazard ratios for death with an abnormal cTnT concentration were 4.37 (95% confidence intervals [95% CI], 3.21 to 6.22), 6.15 (95% CI, 2.95 to 140.9), 6.30 (95% CI, 3.12 to 21.23), 1.33 (95% CI, 0.56 to 4.85), and 1.46 (95% CI, 0.46 to 9.21) for eGFR≥60, 45 to <60, 30 to <45, 15 to <30, and <15 ml/min per 1.73 m(2) or on dialysis, respectively. Compared with patients with eGFR≥60 ml/min per 1.73 m(2), the adjusted hazard ratio was significantly lower for patients with eGFR=15 to <30 ml/min per 1.73 m(2) (interaction P value=0.02). Redefining abnormal cTnT concentration as ≥0.03 ng/ml or a change of ≥0.02 ng/ml did not alter results. Because the risk associated with postoperative cTnT levels may be different for patients with eGFR<30 ml/min per 1.73 m(2), additional research is required to determine how to interpret perioperative cTnT values for patients with low kidney function.
authors.affiliation: Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Canada; lastwalsh1975@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Walsh
authors.affiliation: Departments of Anesthesiology and.
authors.forename: Chew-Yin
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Departments of Anesthesiology and.
authors.forename: Gracie S Y
authors.initials: GS
authors.lastname: Ong
authors.affiliation: Departments of Anesthesiology and.
authors.forename: Alvin S B
authors.initials: AS
authors.lastname: Tan
authors.affiliation: Departments of Anesthesiology and.
authors.forename: Marzida
authors.initials: M
authors.lastname: Mansor
authors.affiliation: Departments of Anesthesiology and.
authors.forename: Ina I
authors.initials: II
authors.lastname: Shariffuddin
authors.affiliation: Departments of Anesthesiology and.
authors.forename: Noorjahan H M
authors.initials: NH
authors.lastname: Hashim
authors.affiliation: Departments of Anesthesiology and.
authors.forename: Hou Yee
authors.initials: HY
authors.lastname: Lai
authors.affiliation: Medicine, University of Malaya, Kuala Lumpur, Malaysia;
authors.forename: A Wahab
authors.initials: AW
authors.lastname: Undok
authors.affiliation: Departments of Anesthesiology and.
authors.forename: Ushananthini N
authors.initials: UN
authors.lastname: Kolandaivel
authors.affiliation: Departments of Anesthesiology and.
authors.forename: Vasanthan
authors.initials: V
authors.lastname: Vajiravelu
authors.affiliation: Departments of Medicine and Epidemiology and Biostatistics, Western University, London, Canada;
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Epidemiology and Biostatistics, Western University, London, Canada;
authors.forename: Meaghan
authors.initials: M
authors.lastname: Cuerden
authors.affiliation: Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada;
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada;
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Cardiac Program, George Institute for Global Health, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; and.
authors.forename: John
authors.initials: J
authors.lastname: Mooney
authors.affiliation: Centre for Transplant and Renal Research, University of Sydney at Westmead Millennium Institute, Sydney, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lee
authors.affiliation: Cardiac Program, George Institute for Global Health, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; and.
authors.forename: Clara
authors.initials: C
authors.lastname: Chow
authors.affiliation: Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Canada;
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Devereaux
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T
keywords: CKD; cardiovascular disease; epidemiology and outcomes; risk factors; survival