Postoperative troponin-T predicts prolonged intensive care unit length of stay following cardiac surgery

被引:40
作者
Baggish, AL [1 ]
MacGillivray, TE
Hoffman, W
Newell, JB
Lewandrowski, KB
Lee-Lewandrowski, E
Anwaruddin, S
Siebert, U
Januzzi, JL
机构
[1] Massachusetts Gen Hosp, Dept Med, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Cardiac Surg, Boston, MA 02114 USA
[3] Massachusetts Gen Hosp, Dept Clin Chem, Boston, MA 02114 USA
[4] Massachusetts Gen Hosp, Inst Technol Assessment, Boston, MA 02114 USA
[5] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA
关键词
troponins; cardiac surgery; outcomes; complications; length of stay; intensive care unit;
D O I
10.1097/01.CCM.0000139692.19371.7C
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To evaluate the use of postoperative cardiac troponin T (cTnT) for the prediction of prolonged intensive care unit length of stay following cardiac surgery. Design: Prospective, single-center, observational cohort study of patients following cardiac surgical procedures. The enrollment period was from October through December 2000. Patients were enrolled on admission to the intensive care unit and followed until hospital discharge. Setting. The cardiac surgical intensive care unit of the Massachusetts General Hospital. Patients. A total of 222 consecutive patients were enrolled. Interventions. None. Measurements and Main Results. Perioperative clinical factors and serum concentrations of cTnT measured every 8 hrs after surgery were recorded. These clinical factors and the results of serum cTnT measurement were correlated with the need for prolonged intensive care unit length of stay (defined as >24 hrs). Univariable analysis identified factors predictive of prolonged intensive care unit length of stay. Stepwise logistic regression identified independent predictors of prolonged intensive care unit length of stay. Multiple linear regression was used to explore the direct relationship between cTnT concentrations at several postoperative time points and intensive care unit length of stay. At each time point assessed, cTnT concentrations from patients requiring a prolonged intensive care unit length of stay were significantly higher (all p < .001) than in those individuals with normal length of stay. In contrast, creatine kinase isoenzymes were not significantly different between patients with normal or prolonged intensive care unit length of stay. Multivariable analysis demonstrated that an immediate postoperative cTnT concentration 1.58 ng/mL was the strongest predictor of a prolonged intensive care unit length of stay (odds ratio, 5.6; 95% confidence interval, 2.9-10.8). Multiple linear regression analysis revealed that intensive care unit length of stay increased by 0.32 days with each incremental 1.0 ng/mL increase in cTnT measured at 18-24 hrs postprocedure. Conclusions. Elevated postoperative cTnT concentrations can prospectively identify patients requiring prolonged intensive care unit length of stay after cardiac surgery.
引用
收藏
页码:1866 / 1871
页数:6
相关论文
共 14 条
[1]   Factors that predict prolonged length of stay after aortic surgery [J].
Chang, JK ;
Calligaro, KD ;
Lombardi, JP ;
Dougherty, MJ .
JOURNAL OF VASCULAR SURGERY, 2003, 38 (02) :335-339
[2]  
Christakis G T, 1996, Cardiovasc Surg, V4, P29, DOI 10.1016/0967-2109(96)83780-X
[3]  
HAVILL JH, 1992, NEW ZEAL MED J, V105, P3
[4]   NATIONAL ESTIMATES OF INTENSIVE-CARE UTILIZATION AND COSTS - CANADA AND THE UNITED-STATES [J].
JACOBS, P ;
NOSEWORTHY, TW .
CRITICAL CARE MEDICINE, 1990, 18 (11) :1282-1286
[5]   A comparison of cardiac troponin T and creatine kinase-MB for patient evaluation after cardiac surgery [J].
Januzzi, JL ;
Lewandrowski, K ;
MacGillivray, TE ;
Newell, JB ;
Kathiresan, S ;
Servoss, SJ ;
Lee-Lewandrowski, E .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (09) :1518-1523
[6]  
Kathiresan S, 2003, J AM COLL CARDIOL, V41, p352A
[7]  
KRUEGER H, 1992, CAN MED ASSOC J, V146, P163
[8]   Parsonnet score is a good predictor of the duration of intensive care unit stay following cardiac surgery [J].
Lawrence, DR ;
Valencia, O ;
Smith, EEJ ;
Murday, A ;
Treasure, T .
HEART, 2000, 83 (04) :429-432
[9]   Determinants of duration of ICU stay after coronary artery bypass graft surgery [J].
Michalopoulos, A ;
Tzelepis, G ;
Pavlides, G ;
Kriaras, J ;
Dafni, U ;
Geroulanos, S .
BRITISH JOURNAL OF ANAESTHESIA, 1996, 77 (02) :208-212
[10]   Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients [J].
Neill, F ;
Sear, JW ;
French, G ;
Lam, H ;
Kemp, M ;
Hooper, RJL ;
Foex, P .
ANAESTHESIA, 2000, 55 (07) :641-647