Mildly Elevated Cardiac Troponin below the 99th-Percentile Upper Reference Limit after Noncardiac Surgery

Postoperative elevated cardiac troponin levels predict all-cause mortality and major adverse cardiovascular events following noncardiac surgery: A dose-response meta-analysis of prospective studies

STUDY OBJECTIVE

To perform a dose-response meta-analysis for the association between postoperative myocardial injury (PMI) in noncardiac surgery and the risk of all-cause mortality or major adverse cardiovascular event (MACE).

DESIGN

Dose-response meta-analysis of prospective studies with weighted (WL) or generalized (GL) linear and restricted cubic spline (RCS) regression.

SETTING

Teaching hospitals.

PATIENTS

Adult patients undergoing noncardiac surgery.

INTERVENTIONS

No.

MEASUREMENTS

The primary outcome was all-cause mortality. The secondary outcome was MACE.

MAIN RESULTS

29 studies (53,518 patients) were included. The overall incidence of PMI was 26.0% (95% CI 21.0% to 32.0%). Compared to those without PMI, patients with PMI had an increased risk of all-cause mortality at short- (<12 months) (cardiac troponin[cTn]I: unadj OR 1.71,95%CI 1.22 to 2.41, P < 0.001; cTnT: unadj OR 2.33,95%CI 2.07 to 2.63, P < 0.001), and long-term (≥ 12 months) (cTnI: unadj OR 1.80, 95%CI 1.63 to 1.99; cTnT: unadj OR 1.47,95%CI 1.33 to 1.62) (All P < 0.001) follow-up. For MACE, the group with elevated values was associated with an increased risk (cTnI: unadj OR 1.98, 95% CI 1.13 to 3.47, P = 0.018; cTnT: unadj OR 2.29, 95% CI 1.88 to 2.79, P < 0.001). Dose-response analysis showed positive associations between PMI (per 1× upper reference limit[URL] increment) and all-cause mortality both at short- (unadj OR) (WL, OR 1.09, 95% CI 1.09 to 1.10; GL, OR 1.06, 95% CI 1.06 to 1.07; RCS in the range of 1-2× URL, OR = 2.43, 95%CI 2.25 to 2.62) and long-term follow-up (unadj HR) (WL, OR 1.16, 95% CI 1.14 to 1.17; GL, OR 1.15, 95% CI 1.13 to 1.16; RCS in the range of 1-2.75× URL, OR = 1.23, 95%CI 1.13 to 1.33), and MACE at longest follow-up (unadj OR) (WL: OR 1.53, 95% CI 1.49 to 1.57; GL: OR 1.46, 95% CI 1.42 to 1.50; RCS in the range of 1-2 x URL, OR = 3.10, 95%CI 2.51 to 3.81) (All P < 0.001). For mild cTn increase below URL, the risk of mortality increased with every increment of 0.25xURL (WL, OR 1.03, 95% CI 1.02 to 1.03; GL, OR 1.05, 95% CI 1.03 to 1.07; RCS in the range of 0-0.5 URL, OR = 9.41, 95% CI 7.41 to 11.95) (All P < 0.001).

CONCLUSIONS

This study shows positive WL or GL and RCS dose-response relationships between PMI and all-cause mortality at short (< 12 mons)- and long-term (≥ 12 mons) follow-up, and MACE at longest follow-up. For mild cTn increase below URL, the risk of mortality also increases even with every increment of 0.25× URL.

Association between High-Sensitivity Cardiac Troponin I and Clinical Prognosis of Neurosurgical and Neurocritically Ill Patients

To investigate whether high-sensitivity troponin I (hs-TnI) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Among neurosurgical patients admitted to the intensive care unit (ICU) from January 2013 to December 2019, those whose serum hs-TnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with hs-TnI elevation was matched to a control patient. The primary endpoint was in-hospital mortality and the secondary outcome was MACEs. The hs-TnI elevation was shown in 848 (14.1%) of 6004 patients. After propensity score matching, 706 pairs of data were generated by 1:1 individual matching without replacement. In multivariable analysis of overall and propensity score-matched population, hs-TnI elevation was associated with in-hospital mortality (adjusted odds ratio (OR): 2.37, 95% confidence interval (CI): 1.68–3.33 and adjusted OR: 1.89, 95% CI: 1.28–2.81, respectively). In addition, hs-TnI elevation was associated with MACEs (adjusted OR: 2.73, 95% CI: 1.74–4.29 and adjusted OR: 2.64, 95% CI: 1.60–4.51, respectively). In this study, hs-TnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.

The Effect of Humanistic Care Combined with Predictive Nursing on Negative Emotions and Incidence of Cardiovascular Events in Hemodialysis Patients

Objective

To explore the effect of humanistic care combined with predictive nursing on the negative emotions and incidence of cardiovascular events in hemodialysis patients.

Methods

A total of 90 patients undergoing hemodialysis in our hospital from December 2020 to September 2021 were selected as the research subjects and divided into the study group (n = 45) and the control group (n = 45) by the random number table method. The patients in the control group were given routine nursing, and the patients in the study group were given humanistic care combined with predictive nursing. The effects between the two groups were compared.

Results

After nursing, cardiac troponin I (cTn I) level, Hamilton Depression Scale (HAMD) scores, and Hamilton Anxiety Scale (HAMA) scores in the two groups decreased, and the scores were lower in the study group than the control group (P < 0.05). The World Health Organization on Quality of Life Brief Scale (WHOQOL-BREF) scores in both groups increased and were higher in the study group than the control group (P < 0.05). The nursing satisfaction in the study group was higher than that in the control group, and the incidence of cardiovascular adverse events in the study group was lower than that in the control group (P < 0.05).

Conclusion

In the process of hemodialysis, the application of humanistic care combined with predictive nursing to hemodialysis patients can significantly decrease the cTn I level, reduce the negative emotions of patients, improve the quality of life and nursing satisfaction of patients, and reduce the occurrence of adverse cardiovascular events.

Dose-response effect of postprocedural elevated cardiac troponin level on adverse clinical outcomes following adult noncardiac surgery: a systematic review protocol of prospective studies

INTRODUCTION

Myocardial injury after noncardiac surgery has been recognised as an important complication associated with short-term and long-term morbidity and mortality. However, whether a higher level of postoperative cardiac troponin (cTn) is associated with a higher incidence of major complications remains controversial. Hence, we will conduct a comprehensive dose-response meta-analysis based on all relevant prospective studies to quantitatively evaluate the association between elevated postoperative cTn levels and short-/long-term adverse clinical outcomes following adult noncardiac surgery.

METHODS

We will search the PubMed, EMBase, Cochrane Library, ISI Knowledge via Web of Science, China National Knowledge Infrastructure, Wanfang and VIP databases (from inception until October 2020) to identify all prospective cohort studies using the relevant keywords. The primary outcome will be all-cause mortality. The secondary outcomes will include cardiovascular mortality and major adverse cardiovascular events (MACEs). Univariable or multivariable meta-regression and subgroup analyses will be conducted for the comparison between elevated versus nonelevated categories of postoperative cTn levels. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of all-cause mortality or MACE. To conduct a dose-response meta-analysis for the potential linear or restricted cubic spline regression relationship between postoperative elevated cTn levels and all-cause mortality or MACE, studies with three or more categories will be included.

ETHICS AND DISSEMINATION

Ethical approval is waived for the systematic review protocol according to the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42020173175.

Optimal cut-off value of elevated cardiac troponin concentrations for myocardial injury predicts clinical outcomes in adult patients with COVID-19: a dose-response analysis protocol for systematic review

INTRODUCTION

Acute myocardial injury in patients with COVID-19 infection has been recognised as one important complication associated with in-hospital mortality. The potential dose-response effect of cardiac troponin (cTn) concentrations on adverse clinical outcomes has not been systematically studied. Hence, we will conduct a comprehensive dose-response meta-analysis to quantitatively evaluate the relationship between elevated cTn concentrations and in-hospital adverse clinical outcomes in patients with COVID-19.

METHODS

We will search PubMed, EMBASE, Cochrane Library and ISI Knowledge via Web of Science databases, as well as preprint databases (medRxiv and bioRxiv), from inception to October 2021, to identify all retrospective and prospective cohorts and randomised controlled studies using related keywords. The primary outcome will be all-cause mortality during hospitalisation. The secondary outcome will be major adverse event (MAE). To conduct a dose-response meta-analysis of the potential linear or restricted cubic spline regression relationship between elevated cTn concentrations and all-cause mortality or MAE, studies with three or more categories of cTn concentrations will be included. Univariable or multivariable meta-regression and subgroup analyses will be conducted to compare elevated and non-elevated categories of cTn concentration. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of all-cause mortality or MAE.

ETHICS AND DISSEMINATION

In accordance with the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital, ethical approval was waived for this systematic review protocol. This meta-analysis will be disseminated through a peer-reviewing process for journal publication and conference communication.

PROSPERO REGISTRATION NUMBER

CRD42020216059.