Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death

Walsh, M. and Wang, C.Y. and Ong, G.S.Y. and Tan, A.S.B. and Mansor, M. and Shariffuddin, I.I. and Hashim, N.H.M. and Lai, H.Y. and Undok, A.W. and Kolandaivel, U.N. and Vajiravelu, V. and Garg, A.X. and Cuerden, M. and Guyatt, G. and Thabane, L. and Mooney, J. and Lee, V. and Chow, C. and Devereaux, P.J. (2015) Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death. Journal of the American Society of Nephrology, 26 (10). pp. 2571-2577. ISSN 1046-6673

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Cardiac troponin T (cTnT), even at low concentrations, is a risk factor for 30-day mortality in patients undergoing noncardiac surgery, but it is uncertain whether that risk is generalizable to patients with poor kidney function. We, therefore, evaluated the relationship between cTnT concentration and kidney function on the outcome of 30-daymortality in a post hoc analysis of a prospective cohort study of patients undergoing noncardiac surgery. cTnT was measured for 3 days after surgery and considered abnormal if the peak was ≥ 0.02 ng/ml. Of the included 14,037 patients, 267 (1.9%) patients died within 30 days of surgery. The adjusted hazard ratios for death with an abnormal cTnT concentration were 4.37 (95% confidence intervals [95%CI], 3.21 to 6.22), 6.15 (95%CI, 2.95 to 140.9), 6.30 (95%CI, 3.12 to 21.23), 1.33 (95% CI, 0.56 to 4.85), and 1.46 (95% CI, 0.46 to 9.21) for eGFR ≥ 60, 45 to ,60, 30 to ,45, 15 to ,30, and ,15 ml/min per 1.73m2 or on dialysis, respectively. Comparedwith patientswith eGFR ≥ 60 ml/min per 1.73m2, the adjusted hazard ratio was significantly lower for patients with eGFR=15 to ,30 ml/min per 1.73 m2 (interaction P value=0.02). Redefining abnormal cTnT concentration as $0.03 ng/ml or a change of ≥ 0.02 ng/ml did not alter results. Because the risk associated with postoperative cTnT levelsmay be different for patients with eGFR ≥ 30 ml/min per 1.73 m2, additional research is required to determine how to interpret perioperative cTnT values for patients with low kidney function.

Item Type: Article
Uncontrolled Keywords: Aged; Female; Humans; Kidney; Male; Middle Aged; Postoperative Complications; Prognosis; Prospective Studies; Troponin T
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 01 Oct 2018 01:27
Last Modified: 01 Oct 2018 01:27

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