Association of preoperative electrocardiographic markers with sepsis in elderly patients after general surgery

Abstract Background Electrocardiographic markers, as surrogates for sympathetic excitotoxicity, are widely predictive of cardiovascular adverse events, but whether these markers can predict postsurgical sepsis (SS) is unclear. Methods We retrospectively analyzed patients who underwent abdominal surgery from March 2013 to May 2023. We collected basic data, comorbidities, blood samples, echocardiology, electrocardiogram, and surgical data, as well as short-term outcome. The primary endpoints were postsurgical SS, in which logistic regression analyses can identify independent risk factors. The optimal cut-off value predictive postsurgical SS both P wave and PR interval were calculated in the receiver operating characteristic curve (ROC). Results A total of 1988 subjects were analyzed, and the incidence of postsurgical SS was 3.8%. The mean age at enrollment was 68.6 ± 7.1 years, and 53.2% of the participants were men. In the ROC analysis, the areas under the curve (AUC) for P wave and PR interval predictive postsurgical SS were 0.615 (95%CI, 0.548–0.683; p = 0.001) and 0.618 (95%CI, 0.554–0.682; p = 0.001), respectively. The P wave and PR interval predicted postoperative sepsis with optimal discrimination of 103 and 157 ms, with a sensitivity of 0.744 and 0.419, and a specificity of 0.427 and 0.760. P-wave less than 103 ms or PR interval less than 157 ms associated with a 2.06 or 2.33 fold increase occurred risk postsurgical SS. Conclusions Shorter P-wave and PR intervals were both independently associated with postsurgical SS. These preoperative electrophysiological markers could have potential useful for early recognition of postoperative SS

Phenotypes of hiPSCs and somatic cells (HSFs).

<p>White histograms represent the surface expression of MHC-I, MHC-II, HLA-G, HLA-E, CD40, CD80, and CD86, and gray histograms represent isotype controls. Data shown here are representative of three different experiments.</p

Characterization of hiPSCs.

<p>(A) Expression of human ES cell-specific cell surface markers on hiPSCs were analyzed by flow cytometry. Gray histograms: isotype controls; White histograms: positive staining of antigens. (B) Various tissues of all three germ layers present in teratomas derived from hiPSCs. Hematoxylin and eosin staining of teratoma sections. Scale bars, 500 µm.</p

Phenotypes of hiPSCs and somatic cells (HSFs).

<p>White histograms represent the surface expression of MHC-I, MHC-II, HLA-G, HLA-E, CD40, CD80, and CD86, and gray histograms represent isotype controls. Data shown here are representative of three different experiments.</p

hiPSCs induced the generation of IL-2- and IL-10-secreting T cells in MRL.

<p>Allogeneic PBMCs (responder cells; R) were co-cultured with hiPSCs (stimulator cells; S) at an R/S ratio of 10∶1 for 24 hours. The intracellular expressions of IL-2 and IL-10 in CD3⁺CD4⁺ and CD3⁺CD8⁺ T cells were examined by flow cytometry (A, B) (n = 7). Data shown as the mean ± SEM are representative of seven separate experiments. * <i>P<</i>0.05; ** P<0.01; *** P<0.001.</p