【原】【罂粟摘要】术前生长分化因子-15的浓度与非心脏大手术后心血管事件的相关性

术前生长分化因子-15的浓度与非心脏大手术后心血管事件的相关性

贵州医科大学    麻醉与电生理课题组

翻译：黄祥      编辑：杨荣峰      审校：曹莹

01

背景

既往研究已经证实生长分化因子-15的浓度与心血管疾病之间存在显著相关性。本研究假设，除了临床评估外，生长分化因子-15可能有助于非心脏手术患者的心脏风险分层。

02

方法

本研究的目的是确定术前生长分化因子-15是否与非心脏手术后30天内心肌损伤和血管性死亡的复合主要结局相关，并且是否有助于改善非心脏手术的心脏风险预测。这是一项前瞻性队列研究，研究对象为45岁及以上接受非心脏大手术的患者。在对改良心脏风险指数进行校正后，评估术前生长分化因子-15与主要结局之间的关系。此外，术前还纳入了N-末端脑钠肽前体，以比较生长分化因子-15的评估预测性能。

03

结果

在2008年10月27日-2013年10月30日期间，共有5,238例患者被纳入研究，这些患者在术前进行了生长分化因子-15的测量（中位数，1,325；四分位距，880 pg/ml - 2132 pg/ml）。在生长分化因子-15浓度<1000 pg/ml的患者中，非心脏手术后心肌损伤和血管性死亡的风险为1705例中有99例（5.8%）；生长分化因子-15浓度在1000 pg/ml - 1500 pg/ml的患者中，该风险为1332例中有161例（12.1%）；生长分化因子-15浓度在1500 pg/ml - 3000 pg/ml的患者中，该风险为1476例中有302例（20.5%）；生长分化因子-15浓度≥3000 pg/ml的患者中，该风险为725例中有247例（34.1%）。与生长分化因子-15浓度<1000 pg/ml的患者相比，各生长分化因子-15浓度组对应的校正后风险比分别为1.93（95%CI，1.50-2.48）、3.04（95%CI，2.41-3.84）和4.8（95%CI，3.76-6.14）。与单独使用改良心脏风险指数相比，生长分化因子-15的纳入可提升30.1%（301/1000）的心脏风险分类的预测能力。此外，在术前N-末端脑钠肽前体和改良心脏风险指数的组合之外，生长分化因子-15的纳入可提升16.1%（161/1000）的风险分类的预测能力。

04

结论

生长分化因子-15与非心脏手术患者术后30天主要心血管事件风险显著相关，且能显著提高心脏风险预测能力的准确性。

原始文献来源：Duceppe E,Borges FK,Conen D, et al. Association of Preoperative Growth Differentiation Factor-15 Concentrations and Postoperative Cardiovascular Events after Major Noncardiac Surgery. Anesthesiology. 2023;138 (5):508-522.

英文原文

Association of Preoperative Growth Differentiation Factor-15 Concentrations and Postoperative Cardiovascular Events after Major Noncardiac Surgery

Abstract

Background

The association between growth differentiation factor-15 concentrations and cardiovascular disease has been well described. The study hypothesis was that growth differentiation factor-15 may help cardiac risk stratification in noncardiac surgical patients, in addition to clinical evaluation.

Methods

The objective of the study was to determine whether preoperative serum growth differentiation factor-15 is associated with the composite primary outcome of myocardial injury after noncardiac surgery and vascular death at 30 days and can improve cardiac risk prediction in noncardiac surgery. This is a prospective cohort study of patients 45 yr or older having major noncardiac surgery. The association between preoperative growth differentiation factor-15 and the primary outcome was determined after adjusting for the Revised Cardiac Risk Index. Preoperative N-terminal-pro hormone brain natriuretic peptide was also added to compare predictive performance with growth differentiation factor-15.

Results

Between October 27, 2008, and October 30, 2013, a total of 5,238 patients were included who had preoperative growth differentiation factor-15 measured (median, 1,325; interquartile range, 880 to 2,132 pg/ml). The risk of myocardial injury after noncardiac surgery and vascular death was 99 of 1,705 (5.8%) for growth differentiation factor-15 less than 1,000 pg/ml, 161 of 1,332 (12.1%) for growth differentiation factor-15 1,000 to less than 1,500 pg/ml, 302 of 1476 (20.5%) for growth differentiation factor-15 1,500 to less than 3,000 pg/ml, and 247 of 725 (34.1%) for growth differentiation factor-15 concentrations 3,000 pg/ml or greater. Compared to patients who had growth differentiation factor-15 concentrations less than 1,000 pg/ml, the corresponding adjusted hazard ratio for each growth differentiation factor-15 category was 1.93 (95% CI, 1.50 to 2.48), 3.04 (95% CI, 2.41 to 3.84), and 4.8 (95% CI, 3.76 to 6.14), respectively. The addition of growth differentiation factor-15 improved cardiac risk classification by 30.1% (301 per 1,000 patients) compared to Revised Cardiac Risk Index alone. It also provided additional risk classification beyond the combination of preoperative N-terminal-pro hormone brain natriuretic peptide and Revised Cardiac Risk Index (16.1%; 161 per 1,000 patients).

Conclusions

Growth differentiation factor-15 is strongly associated with 30-day risk of major cardiovascular events and significantly improved cardiac risk prediction in patients undergoing noncardiac surgery.

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