Medical Research Council and British Journal of Anaesthesia clinical research training fellowship (grant reference MR/M017974/1) to T.E.F.A.; UK National Institute for Health Research Professorship to R.P.; British Journal ofAnaesthesia/Royal College of Anaesthetists basic science Career Development award, British Oxygen Company research chair grant in anaesthesia from the Royal College of Anaesthetists, and British Heart Foundation Programme Grant (RG/14/4/30736) to G.L.A

Abbott, TEF

Ackland, GL

Ahmad, T

Archbold, RA

Cain, D

Del Arroyo, AG

Edwards, MR

Fowler, AJ

Kam, E

Karmali, SN

Khan, AW

MacDonald, NJ

Niebrzegowska, E

Paredes, LG

Pearse, RM

Reyes, A

Stephens, RCM

Sultan, P

Whittle, JR

Woldman, S

Wragg, A

British Journal of Anaesthesia

Queen Mary Research Online

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

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) &gt;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-1 within 3 days after surgery. We assessed whether myocardial injury was associated with preoperative NLR&gt;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&gt;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&gt;4 [OR: 2.56 (1.92-3.41); P4 is associated with perioperative myocardial injury, independent of conventional risk factors. Systemic inflammation may contribute to the development of perioperative myocardial injury. CLINICAL TRIAL REGISTRATION: NCT01842568

Ackland, G. L.

Abbott, T. E. F.

Cain, D.

Edwards, M. R.

Sultan, P.

Karmali, S. N.

Fowler, A. J.

Whittle, J. R.

MacDonald, N. J.

Reyes, A.

Paredes, L. Gallego

Stephens, R. C. M.

Del Arroyo, A. Gutierrez

Woldman, S.

Archbold, R. A.

Wragg, A.

Kam, E.

Ahmad, T.

Khan, A. W.

Niebrzegowska, E.

Pearse, R. M.

Southampton (e-Prints Soton)

Paredes, L Gallego

Del Arroyo, A Gutierrez

DukeSpace (Duke Univ.)

https://qmro.qmul.ac.uk/xmlui/bitstream/123456789/49203/3/Ackland_Inflammation%20and%20perioperative%20myocardial%20injury_2018_Accepted-ms.pdf

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

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Queen Mary Research Online

Southampton (e-Prints Soton)

DukeSpace (Duke Univ.)