期刊
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
卷 307, 期 21, 页码 2295-2304出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jama.2012.5502
关键词
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资金
- Roche Diagnostics Global Office
- Public Policy Research Fund
- Research Grant Council
- Hong Kong SAR
- Australian College of Anesthesiologists
- New Zealand College of Anesthesiologists
- Instituto de Salud Carlos III
- Fundacio La Marato de TV3
- Canadian Institutes of Health Research
- Pfizer Canada
- Spanish Health Ministry
- Manitoba Medical Services Foundation
- Manitoba Health Research Council
- Univerity of Manitoba Department of Surgery
- Health Sciences Research Foundation
- Abbott
- AstraZeneca
- National Health and Medical Research Council (Australia)
- Christian Medical College, Ludhiana
- McMaster University
- National Institute for Health Research (UK)
- Circassia Holdings plc
- LiDCo Ltd
- Covidien Inc
- Pulsion Medical Systems, Edwards Lifesciences
- Sanofi
- GlaxoSmithKline
- Roche
- Beckman
- Smith Nephew
- DePuy
- American Heart Association
- Heart and Stroke Foundation of Ontario
- Academic Health Science Centres
- Population Health Research Institute
- Clarity Research Group
- Department of Surgery
- Surgical Associates Research Grant
- Hamilton Health Science New Investigator Fund Grant
- Hamilton Health Sciences Grant
- Ontario Ministry of Resource and Innovation
- Stryker Canada
- McMaster University, Department of Anesthesiology
- Saint Joseph's Healthcare-Department of Medicine
- Father Sean O'Sullivan Research Centre
- McMaster University-Department of Medicine
- Hamilton Health Sciences Summer Studentships
- McMaster University-Department of Clinical Epidemiology and Biostatistics
- McMaster University-Division of Cardiology
- Canadian Network Centre for Trials
Context Of the 200 million adults worldwide who undergo noncardiac surgery each year, more than 1 million will die within 30 days. Objective To determine the relationship between the peak fourth-generation troponin T (TnT) measurement in the first 3 days after noncardiac surgery and 30-day mortality. Design, Setting, and Participants A prospective, international cohort study that enrolled patients from August 6, 2007, to January 11, 2011. Eligible patients were aged 45 years and older and required at least an overnight hospital admission after having noncardiac surgery. Main Outcome Measures Patients' TnT levels were measured 6 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We undertook Cox regression analysis in which the dependent variable was mortality until 30 days after surgery, and the independent variables included 24 preoperative variables. We repeated this analysis, adding the peak TnT measurement during the first 3 postoperative days as an independent variable and used a minimum P value approach to determine if there were TnT thresholds that independently altered patients' risk of death. Results A total of 15 133 patients were included in this study. The 30-day mortality rate was 1.9% (95% CI, 1.7%-2.1%). Multivariable analysis demonstrated that peak TnT values of at least 0.02 ng/mL, occurring in 11.6% of patients, were associated with higher 30-day mortality compared with the reference group (peak TnT <= 0.01 ng/mL): peak TnT of 0.02 ng/mL (adjusted hazard ratio [aHR], 2.41; 95% CI, 1.33-3.77); 0.03 to 0.29 ng/mL (aHR, 5.00; 95% CI, 3.72-6.76); and 0.30 ng/mL or greater (aHR, 10.48; 95% CI, 6.25-16.62). Patients with a peak TnT value of 0.01 ng/mL or less, 0.02, 0.03-0.29, and 0.30 or greater had 30-day mortality rates of 1.0%, 4.0%, 9.3%, and 16.9%, respectively. Peak TnT measurement added incremental prognostic value to discriminate those likely to die within 30 days for the model with peak TnT measurement vs without (C index=0.85 vs 0.81; difference, 0.4; 95% CI, 0.2-0.5; P<.001 for difference between C index values). The net reclassification improvement with TnT was 25.0% (P<.001). Conclusion Among patients undergoing noncardiac surgery, the peak postoperative TnT measurement during the first 3 days after surgery was significantly associated with 30-day mortality. JAMA. 2012;307(21):2295-2304 www.jama.com
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