The Predictive Value of High-Sensitive Troponin I for Perioperative Risk in Patients Undergoing Gastrointestinal Tumor Surgery

Abstract

Background: The incidence of cardiovascular events in perioperative period of gastrointestinal tumor surgery cannot be ignored, and studies have shown that postoperative troponin is related to the postoperative risk of non-cardiac surgery. However, the relationship between pre-operative troponin levels and perioperative risk of gastrointestinal tumor surgery is unclear. Thus, we aimed to evaluate the value of high-sensitive cardiac troponin I (hs-cTnI) prior to gastrointestinal tumor surgery for perioperative risk assessment. \n \nMethods: 1259 patients who underwent gastrointestinal tumor surgery and had been tested for hs-cTnI on admission within 7 days prior to surgery were retrospectively recruited. The primary endpoint was in-hospital all-cause mortality and the combined endpoint including death, acute myocardial infarction, cardiac arrest and acute decompensated heart failure. The secondary endpoint included total hospital stay and requirement of intensive care treatment. \n \nFindings: Compared with patients with normal hs-cTnI (≤0.028ng/ml), those with elevated hs-cTnI were more likely to experience the combined endpoint (28·2% versus 2·7%, P < 0·001) and there was also an increasing rate of in mortality in elevated hs-cTnI group (2·4% versus 0·3%, P = 0·057). The length of total hospital stay was significantly prolonged in patients with elevated hs-cTnI (24·8 ± 16·3 versus 19·5 ± 7·9, P = 0·003) and the number of patients requiring intensive care treatment was also higher (22.6% versus 4.2%, P ＜0·001). The area under the ROC curve assessing hs-cTnI in predicting in-hospital mortality was 0·787 [95% confidence interval (CI) 0·612 - 0·963, P = 0·015] and for combined endpoint was 0·822 [95%CI 0·766 - 0·879, P ＜0·001], which was larger than revised cardiac index. Hs-cTnI＞0·028 ng/ml was associated with higher cardiovascular event rate according to the stratification of the revised cardiac index. In multivariate logistic analyses, hs-cTnI was the strongest independent predictor for the combined endpoint [odds ratio (OR) 7·454 (95%CI: 3·872-14·348); P < 0·001]. \n \nInterpretation: High sensitivity troponin I provides powerful prognostic information for patients undergoing gastrointestinal tumor surgery, and therefore provides strong prognostic information incremental to revised cardiac index. \n \nFunding: The Fundamental Research Funds for the Central Universities and the National Natural Science Foundation of China. \n \nDeclaration of Interest: No potential conflict of interest was reported by the authors. \n \nEthics Approval Statement: The study has been approved by the local ethical boards of the sixth affiliated hospital of Sun Yat-sen University.