High-Sensitivity Troponin T Predicts Perioperative Adverse Events in Patients Undergoing Neurosurgical Procedures

Abstract

High-sensitivity troponin T predicts perioperative adverse events in patients undergoing neurosurgical procedures T he early recognition of predictors of adverse outcomes in patients undergoing surgery is important for timely risk strat-ification and management [1]. Clinical risk stratification tools and preoperative laboratory tests have frequently been used as a component of the preoperative workup for patients undergoing various surgical procedures [1]. Several studies have reported that patient factors, comorbidities, and surgical characteristics are associated with a higher incidence of complications in neurosurgery [2, 3]. However, only a few studies have examined the association between preoperative biomarkers and pe-rioperative complications following neurosurgical procedures. Troponins are proteins that regulate the calcium-induced interaction between myosin and actin that results in muscle contraction [4]. Troponin I and troponin T are the most widely used and are the most specific biomarkers for myocyte injury. Elevated troponin levels are a predictor of major adverse events in multiple settings [5, 6]. Multiple studies have demonstrated that preoperative troponin I and T are valuable predictors of worse outcomes not only after cardiac or vascular surgery but also after noncardiac surgeries [7-10]. Although the predictive value of cardiac biomarkers, such as troponins and natriuretic peptides, has been evaluated in various noncardiac surgical Objectives: Previous studies have shown that troponin is a valuable predictor of perioperative complications after non-cardiac surgery. However, the relationship of the preoperative troponin level with perioperative adverse events has not been well described in patients undergoing neurosurgical procedures. The aim of this study was to evaluate the impact of the preoperative high-sensitivity cardiac troponin T (hs-cTnT) level on the outcome of patients who underwent neurosurgery. Methods: The records of 2519 patients who were over 18 years of age and underwent elective neurosurgery between December 2014 and December 2018 were retrospectively evaluated. Patient medical and demographic data and the results of routine preoperative laboratory tests, including the hs-cTnT level, were collected to assess a potential association between these factors and perioperative adverse events. Results: Perioperative adverse events occurred in 251 (10.0%) patients. Older patients and those with more comorbid conditions tended to have a higher rate of perioperative adverse events. The preoperative hs-cTnT level was significantly higher in the individuals who experienced a complicated in-hospital course than in those who did not (21.6±8.2 ng/L vs 6.3±3.1 ng/L; p<0.001). Multivariate analysis indicated that age (odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.16-4.35; p<0.01), the presence of diabetes (OR: 3.13; 95% CI: 1.15-6.32; p=0.004), and a preoperative hs-cTnT level of >18.3 ng/L (OR: 4.51, 95% CI: 2.34-7.82; p<0.001) were significant and independent predictors of periope...