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. 2018 May;38(3):204-211.
doi: 10.3343/alm.2018.38.3.204.

Prognostic Role of High-sensitivity Cardiac Troponin I and Soluble Suppression of Tumorigenicity-2 in Surgical Intensive Care Unit Patients Undergoing Non-cardiac Surgery

Hyun Suk Yang  1 , Mina Hur  2 , Ahram Yi  3 , Hanah Kim  3 , Jayoun Kim  4
Affiliations

Prognostic Role of High-sensitivity Cardiac Troponin I and Soluble Suppression of Tumorigenicity-2 in Surgical Intensive Care Unit Patients Undergoing Non-cardiac Surgery

Hyun Suk Yang et al. Ann Lab Med. 2018 May.

Abstract

Background: The prognostic utility of cardiac biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and soluble suppression of tumorigenicity-2 (sST2), in non-cardiac surgery is not well-defined. We evaluated hs-cTnI and sST2 as predictors of 30-day major adverse cardiac events (MACE) in patients admitted to the surgical intensive care unit (SICU) following major non-cardiac surgery.

Methods: hs-cTnI and sST2 concentrations were measured in 175 SICU patients immediately following surgery and for three days postoperatively. The results were analyzed in relation to 30-day MACE and were compared with the revised Goldman cardiac risk index (RCRI) score.

Results: Overall, 30-day MACE was observed in 16 (9.1%) patients. hs-cTnI and sST2 concentrations differed significantly between the two groups with and without 30-day MACE (P<0.05). The maximum concentration of sST2 was an independent predictor of 30-day MACE (odds ratio=1.016, P=0.008). The optimal cut-off values of hs-cTnI and sST2 for predicting 30-day MACE were 53.0 ng/L and 182.5 ng/mL, respectively. A combination of hs-cTnI and sST2 predicted 30-day MACE better than the RCRI score. Moreover, 30-day MACE was observed more frequently with increasing numbers of above-optimal cut-off hs-cTnI and sST2 values (P<0.0001). Reclassification analyses indicated that the addition of biomarkers to RCRI scores improved the prediction of 30-day MACE.

Conclusions: This study demonstrates the utility of hs-cTnI and sST2 in predicting 30-day MACE following non-cardiac surgery. Cardiac biomarkers would provide enhanced risk stratification in addition to clinical RCRI scores for patients undergoing major non-cardiac surgery.

Keywords: High-sensitivity cardiac troponin I; Non-cardiac surgery; Prognosis; Soluble suppression of tumorigenicity-2.

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Conflict of interest statement

No potential conflicts of interest relevant to this study are reported.

Figures

Fig. 1
Fig. 1. Receiver operator characteristic curve analyses for the prediction of 30-day MACE in patients following major non-cardiac surgeries. The optimal cut-off value of hs-cTnI (max) for prediction of 30-day MACE was 53.0 ng/L (sensitivity, 68.8% [95% CI, 41.3–89.0%]; specificity, 78.6% [95% CI, 71.4–84.7%]) and that of sST2 (max) was 182.5 ng/mL (sensitivity, 87.5% [95% CI, 61.7–98.5%]; specificity, 56.6% [95% CI, 48.5–64.4%]). hs-cTnI (max) and sST2 (max) demonstrated fair predictive ability for 30-day MACE compared with the poor ability of RCRI score, although there was no statistical difference between the AUCs.
Abbreviations: MACE, major adverse cardiac events; CI, confidence interval; RCRI, revised Goldman cardiac risk index; hs-cTnI, high-sensitivity cardiac troponin I; sST2, soluble suppression of tumorigenicity-2; AUC, area under the curve.
Fig. 2
Fig. 2. Thirty-day MACE according to the number of hs-cTnI and sST2 above cut-off values (53.0 ng/L and 182.5 ng/mL, respectively). (A) Overall, 30-day MACE was observed more frequently as the number of above cut-off values increased (P<0.001). (B) This finding was also observed in 148 patients with an RCRI score of 0 or 1 (P<0.001).
Abbreviations: MACE, major adverse cardiac events; CI, confidence interval; RCRI, revised Goldman cardiac risk index; hs-cTnI, high-sensitivity cardiac troponin I; sST2, soluble suppression of tumorigenicity-2; AUC, area under the curve.
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