• Jessica Handke, Anna S Scholz, Sarah Dehne, Johannes Krisam, Hans-Jörg Gillmann, Henrike Janssen, Christoph Arens, Florian Espeter, Florian Uhle, Johann Motsch, Markus A Weigand, and Jan Larmann.
• From the Department of Anaesthesiology, Heidelberg University Hospital (JH, ASS, SD, HJJ, CA, FE, FU, JM, MAW, JL), Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg (JK) and Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany (H-JG).
• Eur J Anaesthesiol. 2020 Oct 1; 37 (10): 908-919.

BackgroundAccurate pre-operative evaluation of cardiovascular risk is vital to identify patients at risk for major adverse cardiovascular and cerebrovascular events (MACCE) after noncardiac surgery. Elevated presepsin (sCD14-ST) is associated with peri-operative MACCE in coronary artery disease (CAD) patients after noncardiac surgery.ObjectivesValidating the prognostic utility of presepsin for MACCE after noncardiac surgery.DesignProspective patient enrolment and blood sampling, followed by post hoc evaluation of pre-operative presepsin for prediction of MACCE.SettingSingle university centre.PatientsA total of 222 CAD patients undergoing elective, inpatient noncardiac surgery.InterventionPre-operative presepsin measurement.Main Outcome MeasuresMACCE (cardiovascular death, myocardial infarction, myocardial ischaemia and stroke) at 30 days postsurgery.ResultsMACCE was diagnosed in 23 (10%) patients. MACCE patients presented with increased pre-operative presepsin (median [IQR]; 212 [163 to 358] vs. 156 [102 to 273] pgml, P = 0.023). Presepsin exceeding the previously derived threshold of 184 pg ml was associated with increased 30-day MACCE rate. After adjustment for confounders, presepsin more than 184 pg ml [OR = 2.8 (95% confidence interval 1.1 to 7.3), P = 0.03] remained an independent predictor of peri-operative MACCE. Predictive accuracy of presepsin was moderate [area under the curve (AUC) = 0.65 (0.54 to 0.75), P = 0.023]. While the basic risk model of revised cardiac risk index, high-sensitive cardiac troponin T and N-terminal fragment of pro-brain natriuretic peptide resulted in an AUC = 0.62 (0.48 to 0.75), P = 0.072, addition of presepsin to the model led to an AUC = 0.67 (0.56 to 0.78), P = 0.009 and (ΔAUC = 0.05, P = 0.438). Additive risk predictive value of presepsin was demonstrated by integrated discrimination improvement analysis (integrated discrimination improvement = 0.023, P = 0.022). Net reclassification improvement revealed that the additional strength of presepsin was attributed to the reclassification of no-MACCE patients into a lower risk group.ConclusionIncreased pre-operative presepsin independently predicted 30-day MACCE in CAD patients undergoing major noncardiac surgery. Complementing cardiovascular risk prediction by inflammatory biomarkers, such as presepsin, offers potential to improve peri-operative care. However, as prediction accuracy of presepsin was only moderate, further validation studies are needed.Trial RegistrationClinicaltrials.gov: NCT03105427.

16 keywords...

hide…