RESUMO
The authors conducted a prospective observational study to investigate the prognostic value of high-sensitivity Troponin I (hs-TnI) in the short- and long-term periods after orthopedic surgery, including Total Hip and Knee Arthroplasty (THA and TKA, respectively), in a tertiary orthopedic center in Brazil. Perioperative Myocardial Injury (PMI) was defined as an absolute increase in hs-TnI of ≥ 26 ng/L above preoperative values. The primary endpoint was all-cause mortality assessed at 30 days and 18 months after surgery. The secondary endpoint consisted of a composite outcome: cardiovascular death, acute myocardial infarction, angina requiring revascularization, and/or stroke. The authors compared Relative Risks (RR) of all-cause mortality and composite outcomes in patients with or without PMI at 30 days and 18 months. A Cox proportional hazards model for long-term outcomes was calculated and adjusted for age > 70 years, gender, and Revised Cardiac Risk Index (RCRI) class ≥ 2. PMI occurred in 3.4 % of all surgeries. At 30-days, 6.6 % of patients with PMI had died versus none without PMI. At 18 months, 20.0 % of PMI versus 4.7 % without PMI had died (RR = 5.0; 95 % Confidence Interval [95 % CI 1.3-19.3]). Based on composite outcomes in short and long-term periods, the RRs were 16.2 (95 % CI 2.7-96.5) and 7.7 (95 % CI 2.2-26.6), respectively. PMI was associated with all-cause mortality after 18 months and increased risk for a composite outcome (Hazard Ratio [HR = 3.97], 95 % CI 1.13-13.89 and HR = 5.80, 95 % CI 1.93-17.45, respectively). Patients with PMI who underwent THA or TKA presented worse short- and long-term prognoses compared to those without PMI.
Assuntos
Artroplastia do Joelho , Infarto do Miocárdio , Idoso , Humanos , Artroplastia do Joelho/efeitos adversos , Prognóstico , Estudos Prospectivos , Troponina , Masculino , FemininoRESUMO
Abstract The authors conducted a prospective observational study to investigate the prognostic value of high-sensitivity Troponin I (hs-TnI) in the short- and long-term periods after orthopedic surgery, including Total Hip and Knee Arthroplasty (THA and TKA, respectively), in a tertiary orthopedic center in Brazil. Perioperative Myocardial Injury (PMI) was defined as an absolute increase in hs-TnI of ≥ 26 ng/L above preoperative values. The primary endpoint was all-cause mortality assessed at 30 days and 18 months after surgery. The secondary endpoint consisted of a composite outcome: cardiovascular death, acute myocardial infarction, angina requiring revascularization, and/or stroke. The authors compared Relative Risks (RR) of all-cause mortality and composite outcomes in patients with or without PMI at 30 days and 18 months. A Cox proportional hazards model for long-term outcomes was calculated and adjusted for age > 70 years, gender, and Revised Cardiac Risk Index (RCRI) class ≥ 2. PMI occurred in 3.4 % of all surgeries. At 30-days, 6.6 % of patients with PMI had died versus none without PMI. At 18 months, 20.0 % of PMI versus 4.7 % without PMI had died (RR = 5.0; 95 % Confidence Interval [95 % CI 1.3-19.3]). Based on composite outcomes in short and long-term periods, the RRs were 16.2 (95 % CI 2.7-96.5) and 7.7 (95 % CI 2.2-26.6), respectively. PMI was associated with all-cause mortality after 18 months and increased risk for a composite outcome (Hazard Ratio [HR = 3.97], 95 % CI 1.13-13.89 and HR = 5.80, 95 % CI 1.93-17.45, respectively). Patients with PMI who underwent THA or TKA presented worse short- and long-term prognoses compared to those without PMI.
RESUMO
Introdução: Resultados de testes laboratoriais apresentam componentes de variação analítica, pré-analítica, bem como variação biológica. A utilização de dados derivados da variação biológica e analítica poderia detectar pequenas mudanças entre dois resultados sucessivos de um mesmo paciente, para analitos que tem um índice de individualidade (II) menor do que 0,6. Objetivo: Descrever as diferenças de resultados laboratoriais sucessivos dos pacientes portadores de AIDS/HIV atendidos no IPEC (Instituto de Pesquisa Clínica Evandro Chagas), utilizando a variação biológica e o coeficiente de variação analítica, com vistas à interpretação dos mesmos, comparando-os aos valores de referência populacionais. Métodos: Estudo seccional seriado ambidirecional de no mínimo 16 resultados laboratoriais consecutivos coletados em 2006 e 2007 de pacientes do HospitalDia e do ambulatório do IPEC; além de variáveis sócio-demográficas. As análises bioquímicas e eletrolíticas foram realizadas no Dimension AR (Dade) e AVL (Roche) respectivamente, e as contagens hematológicas no XT (Sysmex). A análise estatística incluiu: a análise descritiva de dados sócio-demográficos e clínicos; o cálculo do valor de referência para a mudança entre os resultados através de dois cálculos (RCV Reference Change Value) e do índice de individualidade para analitos hematológicos e bioquímicos. Através do Kolmogorov-Smirnov foi avaliada a qualidade do ajuste à distribuição normal dos índices de alerta obtidos pelos três métodos de julgamento, e, o teste de Mann Whitney ou t Student para comparar o desempenho dos mesmos em sinalizar uma alteração entre dois exames consecutivos (índice de alerta). Resultados: A inclusão de 26 pacientes (11 do Hospital Dia e 15 do ambulatório) constituiu uma amostra de 20 homens (76,9 porcento) e seis mulheres (23,1 porcento); 12 brancos (46,2 porcento), três negros (11,5 porcento) e 11 pardos (42,3 porcento); a média de idade foi 37,8 anos (25 62 anos); todos faziam uso de medicamentos que não as drogas anti-retrovirais; a média da contagem de células CD4 e da carga viral no diagnóstico foram, respectivamente, 335 células/mm3 ( 6 a 674 células/mm3) e 232.535 cópias/ml (10.544 - 845.367 cópias/ml). Analitos com II menor do que 0,6: colesterol, creatinina, fosfatase alcalina, hemácias, hematócrito, hemoglobina, plaquetas, leucócitos, ALT (alanina aminotransferase) e triglicerídeos. O RCV apresentou melhor desempenho no monitoramento das mudanças em resultados consecutivos para: albumina (p = 0,04), cloro (p < 0,001), creatinina (p = 0,000), fósforo (p = 0,025), fosfatase alcalina (p = 0,01) e potássio (p < 0,001). O valor de referência populacional apresentou melhor desempenho para: bilirrubina total (p = 0,05), hemácias, hematócrito, hemoglobina, leucócitos, sódio (p< 0,001), e ALT (p=0,002). Conclusão: Nossos resultados evidenciaram adequado desempenho do RCV em monitorar mudanças em resultados seriados de alguns analitos utilizados no monitoramento dos metabolismos hepático e renal em pacientes com AIDS.
Introduction: Laboratory test results are influenced by pre-analytical, analytical and biological variations. Use of analytical and biological variation data has been proposed to detect subtle changes in consecutive tests results with index of individuality (II) smaller than 0.6.Objective: To study differences in consecutive laboratory test results of AIDS (Acquired Immunodeficiency Syndrome) /HIV (Human Immunodeficiency Virus) patients, comparing biological and analytical coefficient variations (CV) with population-based reference values. Method: Ambidirectional cross-sectional study of at least 16 test results collected in AIDS/ HIV subjects in day hospital and on outpatient treatment, between 2006 and 2007 at IPEC. Biochemical and electrolyte assays were performed using Dade Dimension AR and Roche AVL, haemathology counts using XT(Sysmex). Frequencies were described for the following variables: sociodemographic and clinical data, reference change values (RCV) for results and warning indices, II to analytes in hematology and for analytes in biochemistry. Kolmogorov-Smirnov test was used to assess fitness of normal distribution to warning indices provided by the two methods. Mann Whitney or Student t test were used to compare percentual frequencies of altered results (warning indices) in both methods (RCV and population-based reference value). Results: Twenty six AIDS/ HIV subjects (11 in day hospital and 15 on outpatient treatment) has been included, with 20 male (76.9 percent) and six female (23.1 percent) subjects, of which 12 (46.2 percent) were white, three (11.5 percent) black and 11 (42.3 percent) mestizo. Mean age was 37.8 years (range 25-62), all subjects used antiretrovirals and some other kind of medication. Mean CD4 count at diagnosis was 335 cells/mm3 (range 6-674 cells/mm3) and viral load 232.535 copies/ml (10.544 - 845.367 copies/ml). RCV showed better performance than population-based reference values for monitoring changes between two consecutives laboratorial tests for the following analytes: albumin (p = 0.04), chloride (p < 0.001), creatinine (p < 0.001), alkaline phosphatase (p = 0.01), phosphate (p = 0.025), and potassium (p < 0.001). Population-based reference values showed better performance than RCV for ALT (p =0.002), bilirubin total (p = 0.05), RBC, hematocrit, hemoglobin (p < 0.001), leukocytes (p = 0.003) and sodium (p = 0.002). Conclusion: The present results demonstrate adequate performance for RCV at monitoring changes in serial results of certain analytes used to monitor liver and kidney metabolisms in AIDS patients.