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

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 a...

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Main Authors:	Walsh, M., Wang, C.Y., Ong, G.S.Y., Tan, A.S.B., Mansor, M., Shariffuddin, I.I., Hashim, N.H.M., Lai, H.Y., Undok, A.W., Kolandaivel, U.N., Vajiravelu, V., Garg, A.X., Cuerden, M., Guyatt, G., Thabane, L., Mooney, J., Lee, V., Chow, C., Devereaux, P.J.
Format:	Article
Published:	American Society of Nephrology 2015
Subjects:	R Medicine
Online Access:	http://eprints.um.edu.my/19484/ http://dx.doi.org/10.1681/ASN.2014060536
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spelling	my.um.eprints.194842018-10-01T01:27:33Z http://eprints.um.edu.my/19484/ Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death Walsh, M. Wang, C.Y. Ong, G.S.Y. Tan, A.S.B. Mansor, M. Shariffuddin, I.I. Hashim, N.H.M. Lai, H.Y. Undok, A.W. Kolandaivel, U.N. Vajiravelu, V. Garg, A.X. Cuerden, M. Guyatt, G. Thabane, L. Mooney, J. Lee, V. Chow, C. Devereaux, P.J. R Medicine 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. American Society of Nephrology 2015 Article PeerReviewed 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 http://dx.doi.org/10.1681/ASN.2014060536 doi:10.1681/ASN.2014060536
institution	Universiti Malaya
building	UM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Malaya
content_source	UM Research Repository
url_provider	http://eprints.um.edu.my/
topic	R Medicine
spellingShingle	R Medicine Walsh, M. Wang, C.Y. Ong, G.S.Y. Tan, A.S.B. Mansor, M. Shariffuddin, I.I. Hashim, N.H.M. Lai, H.Y. Undok, A.W. Kolandaivel, U.N. Vajiravelu, V. Garg, A.X. Cuerden, M. Guyatt, G. Thabane, L. Mooney, J. Lee, V. Chow, C. Devereaux, P.J. Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death
description	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.
format	Article
author	Walsh, M. Wang, C.Y. Ong, G.S.Y. Tan, A.S.B. Mansor, M. Shariffuddin, I.I. Hashim, N.H.M. Lai, H.Y. Undok, A.W. Kolandaivel, U.N. Vajiravelu, V. Garg, A.X. Cuerden, M. Guyatt, G. Thabane, L. Mooney, J. Lee, V. Chow, C. Devereaux, P.J.
author_facet	Walsh, M. Wang, C.Y. Ong, G.S.Y. Tan, A.S.B. Mansor, M. Shariffuddin, I.I. Hashim, N.H.M. Lai, H.Y. Undok, A.W. Kolandaivel, U.N. Vajiravelu, V. Garg, A.X. Cuerden, M. Guyatt, G. Thabane, L. Mooney, J. Lee, V. Chow, C. Devereaux, P.J.
author_sort	Walsh, M.
title	Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death
title_short	Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death
title_full	Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death
title_fullStr	Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death
title_full_unstemmed	Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death
title_sort	kidney function alters the relationship between postoperative troponin t level and death
publisher	American Society of Nephrology
publishDate	2015
url	http://eprints.um.edu.my/19484/ http://dx.doi.org/10.1681/ASN.2014060536
_version_	1643691002011058176
score	13.211869

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

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