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Tytuł pozycji:

Intraoperative Troponin Elevation in Liver Transplantation Is Independently Associated With Mortality: A Prospective Observational Study.

Tytuł :
Intraoperative Troponin Elevation in Liver Transplantation Is Independently Associated With Mortality: A Prospective Observational Study.
Autorzy :
Vilchez-Monge AL; Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Garutti I; Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Jimeno C; Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Zaballos M; Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Jimenez C; Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Olmedilla L; Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Piñeiro P; Postoperative Care Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Duque P; Postoperative Care Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Salcedo M; Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Asencio JM; Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Lopez-Baena JA; Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Maruszewski P; Department of Pediatric Surgery and Organ Transplantation, Children´s Memorial Health Institute, Warsaw, Poland.
Bañares R; Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Perez-Peña JM; Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.; Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.
Pokaż więcej
Źródło :
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2020 May; Vol. 26 (5), pp. 681-692. Date of Electronic Publication: 2020 Apr 08.
Typ publikacji :
Journal Article; Observational Study
Język :
English
Imprint Name(s) :
Publication: 2004- : Hoboken, NJ : Wiley
Original Publication: Philadelphia, PA : W.B. Saunders Co., c2000-
MeSH Terms :
Liver Transplantation*/adverse effects
Troponin*
Adult ; Biomarkers ; Humans ; Postoperative Period ; Prospective Studies ; Troponin T
References :
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Substance Nomenclature :
0 (Biomarkers)
0 (Troponin)
0 (Troponin T)
Entry Date(s) :
Date Created: 20200117 Date Completed: 20210318 Latest Revision: 20210318
Update Code :
20210319
DOI :
10.1002/lt.25716
PMID :
31944566
Czasopismo naukowe
Intraoperative factors implicated in postoperative mortality after liver transplantation (LT) are poorly understood. Because LT is a particularly demanding procedure, we hypothesized that intraoperative myocardial injury may be frequent and independently associated with early postoperative outcomes. We aimed to determine the association between intraoperative high-sensitivity troponin (hsTn) elevation during LT and 30-day postoperative mortality. A total of 203 adult patients undergoing LT were prospectively included in the cohort and followed during 1 year. Advanced hemodynamic parameters and serial high-sensitivity troponin T (hsTnT) measurements were assessed at 6 intraoperative time points. The optimal hsTnT cutoff level for intraoperative troponin elevation (ITE) was identified. Patients were classified into 2 groups according to the presence of ITE. Independent impact of ITE on survival was assessed through survival curves and multivariate Cox regression analysis. Intraoperative cardiac function was compared between groups. Troponin levels increased early during surgery in the ITE group. Troponin values at abdominal closure were associated with 30-day mortality (area under the receiver operating caracteristic curve, [AUROC], 0.73; P = 0.005). Patients with ITE showing values of hsTnT ≥61 ng/L at abdominal closure presented higher 30-day mortality (29.6% versus 3.4%; P < 0.001). ITE was independently associated with 30-day mortality (hazard ratio, 3.8; 95% confidence interval, 1.1-13.8; P = 0.04) and with worse overall intraoperative cardiac function. The hsTnT upper reference limit showed no discriminant capacity during LT. Intraoperative myocardial injury identified by hsTn elevation is frequently observed during LT, and it is associated with myocardial dysfunction and short-term mortality. Determinations of hsTn may serve as a valuable intraoperative monitoring tool during LT.
(Copyright © 2020 by the American Association for the Study of Liver Diseases.)

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