Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery

Abstract

Background: Systemic inflammation is pivotal in the pathogenesis of cardiovascular disease. As inflammation can directly cause cardiomyocyte injury, we hypothesised that established systemic inflammation, as reflected by elevated preoperative neutrophil-lymphocyte ratio (NLR) >4, predisposes patients to perioperative myocardial injury. Methods: We prospectively recruited 1652 patients aged !45 yr who underwent non-cardiac surgery in two UK centres. Serum high sensitivity troponin T (hsTnT) concentrations were measured on the first three postoperative days. Clinicians and investigators were blinded to the troponin results. The primary outcome was perioperative myocardial injury, defined as hsTnT!14 ng L À1 within 3 days after surgery. We assessed whether myocardial injury was associated with preoperative NLR>4, activated reactive oxygen species (ROS) generation in circulating monocytes, or both. Multivariable logistic regression analysis explored associations between age, sex, NLR, Revised Cardiac Risk Index, individual leukocyte subsets, and myocardial injury. Flow cytometric quantification of ROS was done in 21 patients. Data are presented as n (%) or odds ratio (OR) with 95% confidence intervals. Results: Preoperative NLR>4 was present in 239/1652 (14.5%) patients. Myocardial injury occurred in 405/1652 (24.5%) patients and was more common in patients with preoperative NLR>4 [OR: 2.56 (1.92e3.41); P<0.0001]. Myocardial injury was independently associated with lower absolute preoperative lymphocyte count [OR 1.80 (1.50e2.17); P<0.0001] and higher absolute preoperative monocyte count [OR 1.93 (1.12e3.30); P¼0.017]. Monocyte ROS generation correlated with NLR (r¼0.47; P¼0.03).

Type 2 diabetes is associated with the accumulation of senescent T cells

“…Leucocyte data were obtained from the VISIONUK study (MREC:10/WNo03/25) [19]. Peripheral blood mononuclear cells (PBMCs) were isolated using Ficoll Hypaque (Amersham Biosciences, Little Chalfont, UK).…”

“…All samples were obtained in accordance with the North East York Research Ethics Committee 16/NE/0073. Leucocyte data were obtained from the VISIONUK study (MREC:10/WNo03/25) [19]. Leucocyte subsets were measured using a Sysmex XE2100 analyser (Sysmex, Milton Keynes, UK).…”

Local application of enamel matrix derivative prevents acute systemic inflammation after periodontal regenerative surgery: A randomized controlled clinical trial

“…Non‐cardiac surgery represents a potential cardiovascular risk factor, which could be related to elevated systemic inflammation (Ackland et al, ). In particular, this might be particularly important in patients that are considered at a high‐risk (Kristensen et al, ).…”

“…Higher levels of systemic inflammation have been associated with a significant and independent higher risk of incident cardiovascular disease (Pearson et al, ). Therapeutic interventions are capable of determining a short‐lived acute inflammatory response, which may trigger cardiovascular events as shown by the higher risk of myocardial infarction observed after non‐cardiac surgery (Ackland et al, ).…”

A synthesized heterocyclic chalcone inhibits neutrophilic inflammation through K+‐dependent pH regulation

“…Hence, overwhelming neutrophil immune responses serve a central role in the development of inflammatory injury. Recent research showed that inflammatory injuries mediated by overwhelming neutrophilic immune reactions are essential in the progression of several diseases such as sepsis, ischemia/reperfusion injury, myocardial injury, and acute lung injury 3‐5 . Excessive production of toxic reactive oxygen species (ROS) from activated neutrophils directly destroys lung tissue and indirectly induces interstitial edema due to poorer oxygenation in acute lung injury 6,7 .…”