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Preoperative high-sensitivity troponin I and B-type natriuretic peptide, alone and in combination, for risk stratification of mortality after liver transplantation

대한마취과학회지 2021년 74권 3호 p.242 ~ 253
문영진, Kwon Hye-Mee, Jung Kyeo-Woon, Kim Kyoung-Sun, 신원정, 전인구, 송전골, 황규삼,
소속 상세정보
문영진 ( Moon Young-Jin ) - University of Ulsan College of Medicine Asan Medical Center Department of Anesthesiology and Pain Medicine
 ( Kwon Hye-Mee ) - University of Ulsan College of Medicine Asan Medical Center Department of Anesthesiology and Pain Medicine
 ( Jung Kyeo-Woon ) - University of Ulsan College of Medicine Asan Medical Center Department of Anesthesiology and Pain Medicine
 ( Kim Kyoung-Sun ) - University of Ulsan College of Medicine Asan Medical Center Department of Anesthesiology and Pain Medicine
신원정 ( Shin Won-Jung ) - University of Ulsan College of Medicine Asan Medical Center Department of Anesthesiology and Pain Medicine
전인구 ( Jun In-Gu ) - University of Ulsan College of Medicine Asan Medical Center Department of Anesthesiology and Pain Medicine
송전골 ( Song Jun-Gol ) - University of Ulsan College of Medicine Asan Medical Center Department of Anesthesiology and Pain Medicine
황규삼 ( Hwang Gyu-Sam ) - University of Ulsan College of Medicine Asan Medical Center Department of Anesthesiology and Pain Medicine

Abstract


Background: Given the severe shortage of donor liver grafts, coupled with growing proportion of cardiovascular death after liver transplantation (LT), precise cardiovascular risk assessment is pivotal for selecting recipients who gain the greatest survival benefit from LT surgery. We aimed to determine the prognostic value of pre-LT combined measurement of B-type natriuretic peptide (BNP) and high-sensitivity troponin I (hsTnI) in predicting early post-LT mortality.

Methods: We retrospectively evaluated 2,490 consecutive adult LT patients between 2010 and 2018. Cut-off values of BNP and hsTnI for predicting post-LT 90-day mortality were calculated. According to the derived cut-off values of two cardiac biomarkers, alone and in combination, adjusted hazard ratios (aHR) of post-LT 90-day mortality were determined using multivariate Cox regression analysis.

Results: Mortality rate after 90 days was 2.9% (72/2,490). Rounded cut-off values for post-LT 90-day mortality were 400 pg/ml for BNP (aHR 2.02 [1.15, 3.52], P = 0.014) and 60 ng/L for hsTnI (aHR 2.65 [1.48, 4.74], P = 0.001), respectively. Among 273 patients with BNP ≥ 400 pg/ml, 50.9% of patients were further stratified into having hsTnI ≥ 60 ng/L. Combined use of pre-LT cardiac biomarkers predicted post-LT 90-day mortality rate; both non-elevated: 1.0% (21/2,084), either one is elevated: 9.0% (24/267), and both elevated: 19.4% (27/139, log-rank P < 0.001; aHR vs non-elevated 4.23 [1.98, 9.03], P < 0.001).

Conclusions: Concomitant elevation of both cardiac biomarkers posed significantly higher risk of 90-day mortality after LT. Pre-LT assessment cardiac strain and myocardial injury, represented by BNP and hsTnI values, would contribute to prioritization of LT candidates and help administer target therapies that could modify early mortality.

키워드

B-type natriuretic peptide; Liver transplantation; Mortality; Postoperative Complication; Risk assessment; Troponin-I

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