BACKGROUND Elevated high-sensitivity troponin (hsTnT) after noncardiac surgery is associated with higher mortality, but the temporal relationship between early elevated troponin and the later development of noncardiac morbidity remains unclear. METHODS Prospective observational study of patients aged ≥45 yr undergoing major noncardiac surgery at four UK hospitals (two masked to hsTnT). The exposure of interest was early elevated troponin, as defined by hsTnT >99th centile (≥15 ng L-1) within 24 h after surgery. The primary outcome was morbidity 72 h after surgery, defined by the Postoperative Morbidity Survey (POMS). Secondary outcomes were time to become morbidity-free and Clavien-Dindo ≥grade 3 complications. RESULTS Early elevated troponin (median 21 ng L-1 [16-32]) occurred in 992 of 4335 (22.9%) patients undergoing elective noncardiac surgery (mean [standard deviation, sd] age, 65 [11] yr; 2385 [54.9%] male). Noncardiac morbidity was more frequent in 494/992 (49.8%) patients with early elevated troponin compared with 1127/3343 (33.7%) patients with hsTnT <99th centile (odds ratio [OR]=1.95; 95% confidence interval [CI], 1.69-2.25). Patients with early elevated troponin had a higher risk of proven/suspected infectious morbidity (OR=1.54; 95% CI, 1.24-1.91) and critical care utilisation (OR=2.05; 95% CI, 1.73-2.43). Clavien-Dindo ≥grade 3 complications occurred in 167/992 (16.8%) patients with early elevated troponin, compared with 319/3343 (9.5%) patients with hsTnT <99th centile (OR=1.78; 95% CI, 1.48-2.14). Absence of early elevated troponin was associated with morbidity-free recovery (OR=0.44; 95% CI, 0.39-0.51). CONCLUSIONS Early elevated troponin within 24 h of elective noncardiac surgery precedes the subsequent development of noncardiac organ dysfunction and may help stratify levels of postoperative care in real time.

中文翻译：

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选择性非心脏手术后血浆高敏感性肌钙蛋白T的早期升高和发病率：前瞻性多中心观察队列研究。

背景非心脏手术后高敏感性肌钙蛋白（hsTnT）升高与较高的死亡率相关，但早期肌钙蛋白升高与非心脏发病率发展之间的时间关系尚不清楚。方法前瞻性观察性研究在英国的四家医院（两家对hsTnT进行掩蔽）中接受≥45岁的≥75岁的患者接受了大型非心脏手术。感兴趣的暴露是早期肌钙蛋白升高，这定义为在术后24小时内hsTnT> 99％（≥15 ng L-1）。主要结果是术后72小时的发病率，这是由术后发病率调查（POMS）定义的。次要结局是无病且Clavien-Dindo≥3级并发症的时间。结果早期肌钙蛋白升高（中位21 ng L-1 [16-32]）发生在4335的992中（22。9％）接受了非心脏择期手术的患者（平均[标准差，标准差]年龄：65 [11]岁；男性2385 [54.9％]）。早期肌钙蛋白升高的494/992（49.8％）患者的非心脏发病率高于hsTnT <99％的1127/3343（33.7％）患者（几率[OR] = 1.95； 95％置信区间[CI]， 1.69-2.25）。早期肌钙蛋白升高的患者具有更高的经证实/怀疑的传染病风险（OR = 1.54； 95％CI，1.24-1.91）和重症监护利用率（OR = 2.05； 95％CI，1.73-2.43）。早期肌钙蛋白升高的167/992（16.8％）患者发生了Clavien-Dindo≥3级并发症，而hsTnT <99％的患者为319/3343（9.5％）（OR = 1.78; 95％CI，1.48-2.14） 。早期缺乏肌钙蛋白升高与无发病率恢复相关（OR = 0.44； 95％CI，0.39-0.51）。