Predictive Value of Perioperative Cardiac Troponin I in Patients Undergone Liver Transplantation: A Retrospective Cohort Study

Abstract

Lei Zhang,1,* Shu-Yan Guo,1,* Guan Wang,1 Xi Zheng,2 Hui-Miao Jia,2 Li-Feng Huang,2 Yi-bing Weng,1 Wen-Xiong Li2 1Department of Critical Care, Beijing Lu He Hospital, Capital Medical University, Beijing, 101120, People’s Republic of China; 2Department of Surgical Intensive Care Unit, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yi-bing Weng, Department of Critical Care, Beijing Luhe Hospital, Capital Medical University, 82 Xinhuanan Road, Tongzhou District, Beijing, 101199, People’s Republic of China, Tel [phone], Email [email protected] Wen-Xiong Li, Department of Surgical Intensive Care Unit, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchuang Nanlu, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel/Fax [phone], Email [email protected]: To examine the change rule and clinical significance of cardiac troponin I (cTnI) in the perioperative period of liver transplantation in adults, as well as its association with 28-day mortality.Methods: This was a retrospective cohort study: patients who underwent elective orthotopic liver transplantation (OLT) in Beijing Chao-Yang Hospital between June 2015 and June 2020 were selected, and plasma cTnI values were collected through the electronic medical record system within 7 days after surgery. Furthermore, the baseline clinical data of these patients were collected, and the change curve of cTnI values following liver transplantation was plotted. Using univariate and multivariate logistic regression models, the relationship between the level of postoperative cTnI and short-term mortality was investigated. The primary study endpoint was mortality within 28 days after surgery.Results: We included 414 patients who had undergone liver transplantation in this study, 48 of whom died within 28 days after surgery. cTnI, a specific marker of myocardial injury, could predict that the postoperative cardiovascular complications were higher in the death group and significantly affect the short-term prognosis of patients; however, its prognostic cut-off value was approximately 0.545 ng/mL (13×URL), indicating that a minor elevation of cTnI after liver transplantation did not significantly affect the prognosis. Moreover, a comparison of the baseline data and postoperative ICU management scores of the two groups revealed that diabetes, maximum value of cTnI > 0.545 ng/mL within 7 days, and the need for postoperative renal replacement therapy (RRT) were independent prognostic factors of death within 28 days after liver transplantation.Conclusion: Within 7 days after surgery, an increase in cTnI to the maximum value of 0.545 ng/mL (13×URL) could have a significant impact on the short-term prognosis of patients. Diabetes and postoperative RRT were two independent prognostic factors for liver transplantation perioperative mortality.Keywords: cardiac troponin I, liver transplantation, postoperative myocardial injury, short-term prognosis

Keywords

• cardiac troponin i
• liver transplantation
• postoperative myocardial injury
• short-term prognosis