Prognostic value of perioperative assessment of plasma cardiac troponin I in patients undergoing liver transplantation
An elevation in plasma cardiac troponin is an indicator of increased perioperative risk in orthopaedic and vascular surgery, however data on liver transplantation (LTx) are scarce.
The aim of the study was to evaluate the prevalence of cardiac troponin I (cTnI) elevation in the perioperative period of LTx, and its potential relationship with 1-year mortality.
Material and methods. Analysis included 79 patients with liver cirrhosis. During LTx all patients underwent hemodynamic measurements. cTnI was determined before the operation, 24, 48 and 72 hours afterwards. One-year mortality was assessed.
Results. 12.7% patients died, all during in-hospital period. cTnI on day 1. was identified as the most promising marker of increased death risk with optimal cut-off value of 0.215 ng/ml (the sensitivity of 60.0%, specificity of 87.0%, positive predictive value of 40.0%, negative predictive value of 93.8%).
The most important predictor of cTnI increase was the duration of the LTx procedure followed by packed red blood cells transfused, basic stroke volume index, and cardiac output index.
In conclusion: value of cTnI assessed 24 hours post-surgery was a reliable predictor of death following LTx with optimal cut-off value of 0.215ng/ml. The surgery time was the most important predictor of cTnI elevation.
Pateron D, Beyne P, Laperche T, Logeard D, Leﬁlliatre P, Sogni P, Moreau R et al. Elevated circulating cardiac troponin I in patients with cirrhosis. Hepatology 1999;29:640-643. DOI: 10.1002/hep.510290332
Watt K, Coss E, Pedersen R, Dierkhising R, Heimbach J, Charlton M. Pretransplant serum troponin I levels are highly predictive of patient and graft survival following liver transplantation. Liver Transpl 16:990-998, 2010. DOI: 10.1002/lt.22102
Higham H, Sear JW, Sear YM, Kemp M, Hooper RJL, Foex P. Peri-operative troponin I concentration as a marker of long-term postoperative adverse cardiac outcomes – a study in high-risk surgical patients. Anaesthesia, 2004; 59: 318–323. DOI: 10.1111/j.1365-2044.2004.03660
Bolliger D, Seeberger MD, Lurati-Buse GAL, Christen P, Rupinski B, Gurke L, Filipovic M. A preliminary report on the prognostic significance of preoperative brain natriuretic peptide and postoperative cardiac troponin I in patients undergoing major vascular surgery. Anesth Analg, 2009;108:1069–1075. DOI: 10.1213/ane.0b013e318194f3e6
Landesberg G, Shatz V, Akopnik I, Wolf YG, Mayer M, Berlatzky Y, Weissman C et al. Association of cardiac troponin I, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol 2003;42:1547–54
Devereaux PJ, Goldman L, Yusuf S, Gilbert K, Leslie K, Guyatt GH. Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review. CMAJ 2005;173:779–88. DOI: 10.1503/cmaj.050316
Filipovic M, Jeger R, Probst C, Girard T, Pfisterer M, Gurke L, Skarvan K et al. Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease. J Am Coll Cardiol 2003;42:1767–76
Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, Ford I et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J, 2014;35(35):2383-431. DOI: 10.1097/EJA.0000000000000150
Howell WL, Manion WC. The low incidence of myocardial infarction in patients with portal cirrhosis of the liver: a review of 639 cases of cirrhosis of the liver from 17731 autopsies. Am Heart J, 1960;23:259-260.
Berzigotti A, Bonfiglioli A, Muscari A, Bianchi G, Libassi S, Bernardi M, Zoli M. Reduced prevalence of ischemic events and abnormal supraaortic flow patterns in patients with liver cirrhosis. Liver Int, 2005;25:331-336. DOI: 10.1111/j.1478-3231.2005.01002.x
Balla A, Chobanian M. New-onset diabetes after transplantation: a review of recent literature. Curr Opin Organ Transplant, 2009;14:375-9. DOI: 10.1097/MOT.0b013e32832dbb98
Kockx M, Jessup W, Kritharides L. Cyclosporin A and atherosclerosis - cellular pathways in atherogenesis. Pharmacol Ther. 2010;128:106-18. DOI: 10.1016/j.pharmthera.2010.06.001
Fellström B. Risk factors for and management of post-transplantation cardiovascular disease. BioDrugs. 2001;15:261-78.
Flu W-J, Schouten O, Kuijk J-P, Poldermans D. Perioperative cardiac damage in vascular surgery patients. Eur J Vasc Endovasc Surg, 2010;40:1-8. DOI: 10.1016/j.ejvs.2010.03.014
Chong CP, Lam QT, Ryan JE, Sinnappu RN, Lim WK. Incidence of post-operative troponin I and 1-year mortality after emergency orthopaedic burgery in older patients. Age and Ageing, 2009;38:168-174. DOI: 10.1093/ageing/afn231
Levy M, Heels-Ansdell D, Hiralal R, Bhandari M, Guyatt G, Yusuf S, Cook D et al. Prognostic value of troponin and creatine kinase, muscle and brain isoenzyme measurement after noncardiac surgery. A systematic review and meta-analysis. Anesthesiology 2011;114:796–806. DOI: 10.1097/ALN.0b013e31820ad503.
Devereaux PJ, Chan MT, Alonso-Coello P, Walsh M, Berwanger O, Villar JC, Wang CY et al. Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators. Association between postoperative troponin I levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2012;307(21):2295-2304. DOI: 10.1001/jama.2012.5502
Szczeklik W, Devereaux PJ. Troponin T level and mortality risk after noncardiac surgery: practical implications of the VISION study. Pol Arch Med Wewn. 2012;122(10):499-503.
Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol 2006;48:1-11. DOI: 10.1016/j.jacc.2006.02.056
Patkowski W, Zieniewicz K, Skalski M, Krawczyk M. Correlation between selected prognostic factors and postoperative course in liver transplant recipients. Transplant Proc, 2009;41:3091-102. DOI: 10.1016/j.transproceed.2009.09.038
Hei Z, Liu D, Luo C, Li S, Ma W, Luo G. Perioperative changes of ventricular function and three indicators of myocardial injury during orthotopic liver transplantation. Chinese Med J, 2006;119(11):939-943.
Snipelisky D, Donovan S, Levy M, Satyanarayana R, Shapiro B.
Cardiac troponin I elevation predicts mortality in patients undergoing orthotopic liver transplantation. J Transplant. 2013;2013:252838. DOI: 10.1155/2013/252838
Siniscalchi A, Gamberini L, Mordenti A, Bernardi E, Cimatti M, Riganello I, Toccaceli L et al. Postoperative troponin T elevation as a predictor of early acute kidney injury after orthotopic liver transplantation: a preliminary retrospective study. Transpl Proc, 2012;44,1999–2001. DOI: 10.1016/j.transproceed.2012.06.039
Coss E, Watt K, Pedersen R, Dierkhising R, Heimbach J, Charlton M. Predictors of cardiovascular events after liver transplantation: a role for pre-transplant serum troponin levels. Liver Transpl 2011;17:23-31. DOI: 10.1002/lt.22140
Devereaux PJ, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I, Leslie K et al. Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med 2011;154:523–528. DOI: 10.7326/0003-4819-154-8-201104190-00003
Acta Biochimica Polonica is an open access quarterly and publishes four issues a year. All contents are distributed under the Creative Commons Attribution-ShareAlike 4.0 International (CC BY-SA 4.0) license. Everybody may use the content following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made, ShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. There are no additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Copyright for all published papers © stays with the authors.
Copyright for the journal: © Polish Biochemical Society.