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


BACKGROUND
NCT02150486.
Department of Anaesthesia, Intensive Care and Pain Medicine p.noordzij@antoniusziekenhuis.nl.
P G
PG
Noordzij
Department of Anaesthesia, Intensive Care and Pain Medicine.
O
O
van Geffen
Department of Clinical Chemistry.
I M
IM
Dijkstra
Department of Surgery.
D
D
Boerma
Department of Internal Medicine.
A J
AJ
Meinders
Department of Anaesthesia, Intensive Care and Pain Medicine.
T C D
TC
Rettig
Department of Cardiology.
F D
FD
Eefting
Department of Clinical Chemistry.
D
D
van Loon
Department of Clinical Pharmacy, St Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands.
E M W
EM
van de Garde
Department of Anaesthesia, Intensive Care and Pain Medicine.
E P A
EP
van Dongen
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D023381:Endpoint Determination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000097:blood* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020107:Troponin T / Q000378:metabolism*
D020107:Troponin T
coronary artery disease; general surgery; postoperative complications; troponin T