Elevação da troponina como um marcador de deterioração precoce e mortalidade geral em uma coorte de pacientes cirúrgicos de alto risco

Introdução: Injúria miocárdica após cirurgias não cardíacas é comum e, na maioria das vezes, assintomática. A população-alvo ideal que se beneficiaria, em países de baixa-média renda, de medidas de rotina de troponina ainda não é clara. Objetivos: O objetivo primário do estudo foi avaliar a magnitude da associação entre níveis crescentes de TnTus e mortalidade a curto e longo prazo, numa coorte de pacientes de alto risco cirúrgico em um cenário de países de baixa-média renda. Objetivos secundários: avaliar a associação entre elevação da troponina e internações não planejadas em UTI ou outras complicações, assim como descrever como os médicos manejam essa elevação. Métodos: Coorte prospectiva de 441 pacientes de alto risco cirúrgico submetidos a cirurgia não cardíaca em um hospital brasileiro entre Fevereiro de 2019 e Março de 2020. Os níveis de TnTus foram medidos no pré-operatório, 24 e 48 horas após a cirurgia e estratificados em três grupos: normal (65 ng/L – grande elevação). A análise da sobrevivência determinou a associação entre dano miocárdico e mortalidade em 1 ano. Intervenções médicas foram relatadas, e internações não planejadas em UTI e complicações foram avaliadas por meio de modelos multivariáveis. Resultados: Injúria miocárdica pós-operatória ocorreu em 64% dos pacientes. Mortalidade geral em 30 dias foi de 7.7%. Mortalidade em 30 dias e 1 ano foram mais altas em pacientes com TnTus ≥14ng/L. Mortalidade em 1 ano foi de 15% no grupo da troponina geral vs. 28% e 41% nos grupos de menor e maior elevação, respectivamente. Conclusão: O estudo corrobora a evidência de que a TnTus é um importante marcador de prognóstico e um forte preditor de mortalidade geral pós-cirúrgica. A avaliação da troponina em pacientes de alto risco cirúrgico poderia potencialmente ser utilizada como uma ferramenta para auxiliar na definição da transição de cuidados em cenários com recursos limitados.Introduction: Myocardial injury after noncardiac surgery is common and mostly asymptomatic. It is still unclear the ideal target population that will benefit, in Low-middle income countries (LMIC), from routine troponin measurements. Objectives: The primary aim of this study was to evaluate the magnitude of association between crescent hsTnT levels and short and long-term mortality in a high-risk surgical patient cohort in an LMIC scenario. As secondary objectives, we aimed to evaluate the association between troponin elevation and unplanned intensive care unit (ICU) admissions or complications as well as to describe how clinicians manage troponin elevation. Methods: Prospective cohort of 441 high-risk patients undergoing noncardiac surgery at a Brazilian hospital between February 2019 and March 2020. hsTnT levels were measured preoperatively, 24 and 48 hours after surgery and stratified into three groups: normal (65 ng/L-major elevation). Survival analysis determined the association between myocardial injury and 1-year mortality. Medical interventions were described, and unplanned ICU admission and complications were evaluated using multivariable models. Results: Postoperative myocardial injury occurred in 64% of patients. Overall 30-day mortality was 7.7%. 30-day and 1-year mortality were higher in patients with hsTnT ≥14 ng/L. One-year mortality was 15% in the regular troponin group vs. 28% and 41% for the minor and major elevation groups respectively. Multivariate analysis of 1-year survival showed HR 1.73; (95% CI 1.07-2.82) for minor elevation and HR 2.69 (95% CI 1.54-4.71) for troponin levels >65 ng/L. Patients with altered troponin had more unplanned ICU admissions (11.3% vs. 5%) and complications (71.9% vs. 28.1%). Conclusion: The study supports evidence that hs-TnT is an important prognostic marker and a strongly predictor of all-cause mortality after surgery. Troponin measurement in high-risk surgical patients could potentially be used as tool to scale-up care in LMIC scenarios

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data