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Preoperative cardiac troponin level is associated with all-cause mortality of liver transplantation recipients.

ABSTRACT: This study was aimed to evaluate the association between preoperative high-sensitivity cardiac troponin I (hs-cTnI) level and mortality in patients undergoing liver transplantation (LT). From January 2011 to May 2016, preoperative hs-cTnI level was measured in consecutive 487 patients scheduled for LT. Patients with elevated preoperative hs-cTnI were compared with those who had normal level. The primary outcome was all-cause death in follow-up period of 30 days to 1 year after operation. Of the 487 patients, 58 (11.9%) had elevated preoperative hs-cTnI and 429 (88.1%) had normal preoperative hs-cTnI. In multivariate analysis, the rate of 1-year mortality and 30-day mortality were higher in elevated preoperative hs-cTnI group (hazard ratio [HR], 3.69; confidence interval [CI] 95%, 1.83-7.42; p < 0.001, HR, 6.61; CI, 1.91-22.82; p = 0.003, respectively). After adjustment with inverse probability weighting (IPW), the incidence of 1-year mortality and 30-day mortality were higher in elevated group (HR, 4.66; CI, 3.56-6.1; p < 0.001, HR, 10.31; CI, 6.39-16.66; p < 0.001, respectively). In conclusion, this study showed that in patients who underwent LT, elevation of preoperative hs-cTnI level was associated with 1-year mortality and 30-day mortality.

SUBMITTER: Park J

PROVIDER: S-EPMC5441610 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Preoperative cardiac troponin level is associated with all-cause mortality of liver transplantation recipients.

Park Jungchan J Lee Seung Hwa SH Han Sangbin S Jee Hyun Sook HS Lee Suk-Koo SK Choi Gyu-Seong GS Kim Gaab Soo GS

PloS one 20170523 5

This study was aimed to evaluate the association between preoperative high-sensitivity cardiac troponin I (hs-cTnI) level and mortality in patients undergoing liver transplantation (LT). From January 2011 to May 2016, preoperative hs-cTnI level was measured in consecutive 487 patients scheduled for LT. Patients with elevated preoperative hs-cTnI were compared with those who had normal level. The primary outcome was all-cause death in follow-up period of 30 days to 1 year after operation. Of the ...[more]

PMID: 28542299

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Project description:BackgroundThe triglyceride-glucose (TyG) index, identified as a reliable indicator of insulin resistance (IR), was reported to be associated with stroke recurrence and morbidity in the general population and critically ill patients. However, the relationship in liver transplantation (LT) recipients remains unknown. This study aimed to investigate the correlation between the TyG index and post-LT stroke along with all-cause mortality and further assess the influence of IR on the LT recipients' prognosis.MethodsThe retrospective cohort study enrolled 959 patients who underwent LT at a university-based medical centre between January 2015 and January 2021. The participants were divided into three groups according to their TyG index tertiles. The primary outcome was post-LT stroke. Multivariate logistic regression, COX proportional hazards regression, and restricted cubic spline RCS were used to examine the association between the TyG index and outcomes in LT recipients.ResultsWith a median TyG index of 8.23 (7.78-8.72), 780 (87.18% males) patients were eventually included. The incidence of post-LT stroke was 5.38%, and the in-hospital, 1-year, and 3-year mortality rates were 5.54%, 13.21%, and 15.77%, respectively. Multivariate regression analysis showed an independent association between the TyG index and an increased risk of post-LT stroke [adjusted odds ratio (aOR), 3.398 (95% confidence interval [CI]: 1.371-8.426) P = 0. 008], in-hospital mortality [adjusted hazard ratio (aHR), 2.326 (95% CI: 1.089-4.931) P = 0.025], 1-year mortality [aHR, 1.668 (95% CI: 1.024-2.717) P = 0.039], and 3-year mortality [aHR, 1.837 (95% CI: 1.445-2.950) P = 0.012]. Additional RCS analysis also suggested a linear increase in the risk of postoperative stroke with elevated TyG index (P for nonlinearity = 0.480).ConclusionsThe TyG index may be a valuable and reliable indicator for assessing stroke risk and all-cause mortality in patients undergoing LT, suggesting its potential relevance in improving risk stratification during the peri-LT period.

Project description:BackgroundIncreased postoperative cardiac troponin (cTn) independently predicts short-term mortality. Previous studies suggest that preoperative cTn also predicts major adverse cardiovascular events (MACE) and mortality after noncardiac surgery. The value of preoperative and perioperative changes in cTn as a prognostic tool for adverse outcomes has been sparsely investigated.Methods and findingsA systematic review and meta-analysis of the prognostic value of cTns for adverse outcome was conducted. Adverse outcome was defined as short-term (in-hospital or <30 days) and long-term (>30 days) MACE and/or all-cause mortality, in adult patients undergoing noncardiac surgery. The study protocol (CRD42018094773) was registered with an international prospective register of systematic reviews (PROSPERO). Preoperative cTn was a predictor of short- (OR 4.3, 95% CI 2.9-6.5, p<0.001, adjusted OR 5.87, 95% CI 3.24-10.65, p<0.001) and long-term adverse outcome (OR 4.2, 95% CI 1.0-17.3, p = 0.05, adjusted HR 2.0, 95% CI 1.4-3.0, p<0.001). Perioperative change in cTn was a predictor of short-term adverse outcome (OR 10.1, 95% CI 3.2-32.3, p<0.001). It was not possible to conduct pooled analyses for adjusted estimates of perioperative change in cTn as predictor of short- (a single study identified) and long-term (no studies identified) adverse outcome. Further, it was not possible to conduct pooled analyses for unadjusted estimates of perioperative change in cTn as predictor of long-term adverse outcome, since only one study was identified. Bivariate analysis of sensitivities and specificities were performed, and overall prognostic performance was summarized using summary receiver operating characteristic (SROC) curves. The pooled sensitivity and specificity for preoperative cTn and short-term adverse outcome was 0.43 and 0.86 respectively (area under the SROC curve of 0.68). There were insufficient studies to construct SROCs for perioperative changes in cTn and for long-term adverse outcome.ConclusionOur study indicates that although preoperative cTn and perioperative change in cTn might be valuable predictors of MACE and/or all-cause mortality in adult noncardiac surgical patients, its overall prognostic performance remains uncertain. Future large, representative, high-quality studies are needed to establish the potential role of cTns in perioperative cardiac risk stratification.

Project description:AimsCardio-oncology is a growing interdisciplinary field which aims to improve cardiological care for cancer patients in order to reduce morbidity and mortality. The impact of cardiac biomarkers, echocardiographic parameters, and cardiological assessment regarding risk stratification is still unclear. We aimed to identify potential parameters that allow an early risk stratification of cancer patients.Methods and resultsIn this cohort study, we evaluated 930 patients that were admitted to the cardio-oncology outpatient clinic of the University Hospital Heidelberg from January 2016 to January 2019. We performed echocardiography, including Global Longitudinal Strain (GLS) analysis and measured cardiac biomarkers including N-terminal pro brain-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T levels (hs-cTnT). Most patients were suffering from breast cancer (n = 450, 48.4%), upper gastrointestinal carcinoma (n = 99, 10.6%) or multiple myeloma (n = 51, 5.5%). At the initial visit, we observed 86.7% of patients having a preserved left ventricular ejection fraction (LVEF >50%). At the second follow up, still 78.9% of patients showed a preserved LVEF. Echocardiographic parameters or elevation of NT-proBNP did not significantly correlate with all-cause mortality (ACM) (logistic regression LVEF <50%: P = 0.46, NT-proBNP: P = 0.16) and failed to identify high-risk patients. In contrast, hs-cTnT above the median (≥7 ng/L) was an independent marker to determine ACM (multivariant logistic regression, OR: 2.21, P = 0.0038) among all included patients. In particular, hs-cTnT levels before start of a chemotherapy were predictive for ACM.ConclusionsBased on our non-selected cohort of cardio-oncological patients, hs-cTnT was able to identify patients with high mortality by using a low cutoff of 7 ng/L. We conclude that measurement of hs-cTnT is an important tool to stratify the risk for mortality of cancer patients before starting chemotherapy.

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Preoperative cardiac troponin level is associated with all-cause mortality of liver transplantation recipients.

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Preoperative cardiac troponin level is associated with all-cause mortality of liver transplantation recipients.

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