Geethan Baskaran , Rachel H. Heo MD , Michael K. Wang MD , Pascal B. Meyre MD, PhD , Louis Park , Steffen Blum MD, PhD , P.J. Devereaux MD, PhD , David Conen MD, MPH
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Higher preoperative CRP levels were associated with major cardiovascular events (OR 2.11, 95% CI 1.51–2.94, I<sup>2</sup> = 0%, 2 studies). 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引用次数: 0
摘要
背景非心脏手术与炎症反应有关。方法 系统地检索了从开始到 2023 年 5 月期间的 Medline、EMBASE 和 CENTRAL。如果纵向研究报告了非心脏手术患者术前和/或术后 10 天内测量的生物标志物与至少一种预设不良结局的多变量调整关联，则纳入该研究。数据均独立提取，一式两份。使用 DerSimonian-Laird 随机效应模型对风险估计值进行汇总，并以汇总的几率比 (OR) 和 95% CIs 的形式进行报告。研究结果包括全因死亡率和主要不良心血管事件。中位随访时间为 56 [IQR, 28-63] 个月，平均年龄为 57 (±3) 岁。术前 C 反应蛋白 (CRP) 水平升高与较高的死亡风险有关（OR 1.57，95% CI 1.29-1.90，I2 = 93%，28 项研究）。与癌症手术人群（OR 1.51，95% CI 1.26-1.81，I2 = 83%，24 项研究）相比，非癌症手术人群（OR 2.10，95% CI 1.92-2.31，I2 = 0%，4 项研究）的这一关联性更强（亚组差异 p = 0.001）。同样，术后较高的 CRP 水平与全因死亡率相关（OR 1.61，95% CI 1.17-2.20，I2 = 90%，7 项研究）。术前较高的 CRP 水平与重大心血管事件相关（OR 2.11，95% CI 1.51-2.94，I2 = 0%，2 项研究）。其他术前测量的与全因死亡率相关的生物标志物有纤维蛋白原（OR 1.48，95% CI 1.05-2.09，I2 = 52%，5 项研究）、白细胞介素-6（OR 1.17，95% CI 1.07-1.28，I2 = 27%，3 项研究）和肿瘤坏死因子-α（OR 1.结论和相关性围手术期的炎症生物标志物水平与非心脏手术患者的全因死亡率和不良心血管事件相关。
Associations of inflammatory biomarkers with morbidity and mortality after noncardiac surgery: A systematic review and meta-analysis
Background
Noncardiac surgery is associated with an inflammatory response. Whether increased inflammation in the perioperative period is associated with subsequent morbidity and mortality is unknown.
Methods
MEDLINE, EMBASE, and CENTRAL were systematically searched from date of inception until May 2023. Longitudinal studies were included if they reported multivariable adjusted associations of biomarkers measured preoperatively and/or within 10 days after surgery with at least one prespecified adverse outcome in noncardiac surgery patients. Data were extracted independently and in duplicate. Risk estimates were pooled using DerSimonian-Laird random-effects models and reported as summary odds ratios (ORs) with 95% CIs. The outcomes were all-cause mortality and major adverse cardiovascular events.
Results
Fifty-two studies with a total of 121,849 patients were included. The median follow-up was 56 [IQR, 28–63] months and the average age was 57 (±3) years. Elevated preoperative C-reactive protein (CRP) levels were associated with a higher risk of mortality (OR 1.57, 95% CI 1.29–1.90, I2 = 93%, 28 studies). This association was stronger in non-cancer surgery populations (OR 2.10, 95% CI 1.92–2.31, I2 = 0%, 4 studies) when compared to cancer surgery populations (OR 1.51, 95% CI 1.26–1.81, I2 = 83%, 24 studies) (p for subgroup difference = 0.001). Similarly, higher postoperative CRP levels were associated with all-cause mortality (OR 1.61, 95% CI 1.17–2.20, I2 = 90%, 7 studies). Higher preoperative CRP levels were associated with major cardiovascular events (OR 2.11, 95% CI 1.51–2.94, I2 = 0%, 2 studies). Other preoperatively measured biomarkers associated with all-cause mortality were fibrinogen (OR 1.48, 95% CI 1.05–2.09, I2 = 52%, 5 studies), interleukin-6 (OR 1.17, 95% CI 1.07–1.28, I2 = 27%, 3 studies), and tumour necrosis factor-alpha (OR 1.37, 95% CI 1.16–1.61, I2 = 0%, 2 studies).
Conclusion and relevance
Inflammatory biomarker levels in the perioperative period were associated with all-cause mortality and adverse cardiovascular events in patients undergoing noncardiac surgery.
期刊介绍：
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.
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