Presepsin for pre-operative prediction of major adverse cardiovascular events in coronary heart disease patients undergoing noncardiac surgery

• Verfasst von: Handke, Jessica [VerfasserIn]
• Verfasst von: Scholz, Anna [VerfasserIn]
• Verfasst von: Dehne, Sarah [VerfasserIn]
• Verfasst von: Krisam, Johannes [VerfasserIn]
• Verfasst von: Gillmann, Hans-Jörg [VerfasserIn]
• Verfasst von: Janßen, Henrike [VerfasserIn]
• Verfasst von: Arens, Christoph [VerfasserIn]
• Verfasst von: Espeter, Florian [VerfasserIn]
• Verfasst von: Uhle, Florian [VerfasserIn]
• Verfasst von: Motsch, Johann [VerfasserIn]
• Verfasst von: Weigand, Markus A. [VerfasserIn]
• Verfasst von: Larmann, Jan [VerfasserIn]
• Titel: Presepsin for pre-operative prediction of major adverse cardiovascular events in coronary heart disease patients undergoing noncardiac surgery
• Titelzusatz: post hoc analysis of the Leukocytes and Cardiovascular Peri-operative Events-2 (LeukoCAPE-2) study
• Verf.angabe: Jessica Handke, Anna S. Scholz, Sarah Dehne, Johannes Krisam, Hans-Jörg Gillmann, Henrike Janssen, Christoph Arens, Florian Espeter, Florian Uhle, Johann Motsch, Markus A. Weigand and Jan Larmann
• E-Jahr: 2020
• Jahr: 9 June 2020
• Umfang: 12 S.
• Fussnoten: Gesehen am 17.06.2021
• Titel Quelle: Enthalten in: European journal of anaesthesiology
• Ort Quelle: Philadelphia, Pa. : Lippincott Williams & Wilkins, 1996
• Jahr Quelle: 2020
• Band/Heft Quelle: 37(2020), 10, Seite 908-919
• ISSN Quelle: 1365-2346
• DOI: doi:10.1097/EJA.0000000000001243
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1760767190

Abstract

Background: Accurate pre-operative evaluation of cardiovascular risk is vital to identify patients at risk for major adverse cardiovascular and cerebrovascular events (MACCE) after noncardiac surgery. Elevated presepsin (sCD14-ST) is associated with peri-operative MACCE in coronary artery disease (CAD) patients after noncardiac surgery. - Objectives: Validating the prognostic utility of presepsin for MACCE after noncardiac surgery. - Design: Prospective patient enrolment and blood sampling, followed by post hoc evaluation of pre-operative presepsin for prediction of MACCE. - Setting: Single university centre. - Patients: A total of 222 CAD patients undergoing elective, inpatient noncardiac surgery. - Intervention: Pre-operative presepsin measurement. - Main outcome measures: MACCE (cardiovascular death, myocardial infarction, myocardial ischaemia and stroke) at 30 days postsurgery. - Results: MACCE was diagnosed in 23 (10%) patients. MACCE patients presented with increased pre-operative presepsin (median [IQR]; 212 [163 to 358] vs. 156 [102 to 273] pgml−1, P = 0.023). Presepsin exceeding the previously derived threshold of 184 pg ml−1 was associated with increased 30-day MACCE rate. After adjustment for confounders, presepsin more than 184 pg ml−1 [OR = 2.8 (95% confidence interval 1.1 to 7.3), P = 0.03] remained an independent predictor of peri-operative MACCE. Predictive accuracy of presepsin was moderate [area under the curve (AUC) = 0.65 (0.54 to 0.75), P = 0.023]. While the basic risk model of revised cardiac risk index, high-sensitive cardiac troponin T and N-terminal fragment of pro-brain natriuretic peptide resulted in an AUC = 0.62 (0.48 to 0.75), P = 0.072, addition of presepsin to the model led to an AUC = 0.67 (0.56 to 0.78), P = 0.009 and (ΔAUC = 0.05, P = 0.438). Additive risk predictive value of presepsin was demonstrated by integrated discrimination improvement analysis (integrated discrimination improvement = 0.023, P = 0.022). Net reclassification improvement revealed that the additional strength of presepsin was attributed to the reclassification of no-MACCE patients into a lower risk group. - Conclusion: Increased pre-operative presepsin independently predicted 30-day MACCE in CAD patients undergoing major noncardiac surgery. Complementing cardiovascular risk prediction by inflammatory biomarkers, such as presepsin, offers potential to improve peri-operative care. However, as prediction accuracy of presepsin was only moderate, further validation studies are needed