• Armelle J A Meershoek, Tesse C Leunissen, van WaesJudith A RJARDepartment of Anaesthesiology, University Medical Centre Utrecht, Utrecht, the Netherlands., Wilton A Klei, Albert Huisman, Mark C H de Groot, Imo E Hoefer, Wouter W van Solinge, Frans L Moll, and Gert J de Borst.
• Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
• Eur J Vasc Endovasc Surg. 2020 Feb 1; 59 (2): 309-318.

ObjectiveA pre-operative marker for identification of patients at risk of peri-operative adverse events and 30 day mortality might be the percentage of young, reticulated platelets (pRP). This study aimed to determine the predictive value of pre-operative pRP on post-operative myocardial injury (PMI) and 30 day mortality, in patients aged ≥ 60 years undergoing moderate to high risk non-cardiac surgery.MethodsThe incidence of PMI (troponin I > 0.06 μg/L) and 30 day mortality was compared for patients with normal and high pRP (≥2.82%) obtained from The Utrecht Patient Orientated Database. The predictive pRP value was assessed using logistic regression. A prediction model for PMI or 30 day mortality with known risk factors was compared with a model including increased pRP using the area under the receiving operator characteristics curve (AUROC).ResultsIn total, 26.5% (607/2289) patients showed pre-operative increased pRP. Increased pRP was associated with more PMI and 30 day mortality compared with normal pRP (36.1% vs. 28.3%, p < .001 and 8.6% vs. 3.6%, p < .001). The median pRP was higher in patients suffering PMI and 30 day mortality compared with not (2.21 [IQR: 1.57-3.11] vs. 2.07 [IQR: 1.52-1.78], p = .002, and 2.63 [IQR: 1.76-4.15] vs. 2.09 [IQR: 1.52-3.98], p < .001). pRP was independently related to PMI (OR: 1.28 [95% CI: 1.04-1.59], p = .02) and 30 day mortality (OR: 2.35 [95% CI: 1.56-3.55], p < .001). Adding increased pRP to the predictive model of PMI or 30 day mortality did not increase the AUROC 0.71 vs. 0.72, and 0.80 vs. 0.81.ConclusionIn patients undergoing major non-cardiac surgery, increased pre-operative pRP is related to 30 day mortality and PMI.Copyright © 2019 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

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