Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2022; 10(20): 6865-6875
Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6865
Critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases
Zong-Ming Zhang, Xi-Yuan Xie, Yue Zhao, Chong Zhang, Zhuo Liu, Li-Min Liu, Ming-Wen Zhu, Bai-Jiang Wan, Hai Deng, Kun Tian, Zhen-Tian Guo, Xi-Zhe Zhao
Zong-Ming Zhang, Xi-Yuan Xie, Yue Zhao, Chong Zhang, Zhuo Liu, Li-Min Liu, Ming-Wen Zhu, Bai-Jiang Wan, Hai Deng, Kun Tian, Zhen-Tian Guo, Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
Xi-Zhe Zhao, Department of Cardiology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
Author contributions: Zhang ZM, Xie XY, Zhao Y, Zhang C, Liu Z, Liu LM, Zhu MW, Wan BJ, Deng H, Tian K, Guo ZT, and Zhao XZ performed the diagnosis and treatment; Xie XY, Zhao Y, and Tian K collected and analyzed the data; Zhang ZM provided the funding, designed the study and wrote the manuscript; all authors have read and approved the final version of the manuscript.
Supported by Beijing Municipal Science & Technology Commission, No. Z171100000417056.
Institutional review board statement: The study was approved by the Ethics Committee of Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, with the approval number of KY-2018-101-01-X.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zong-Ming Zhang, MD, PhD, Chief Doctor, Director, Professor, Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Jia No. 1 Taipingqiaoxili, District of Fengtai, Beijing 100073, China. zhangzongming@mail.tsinghua.edu.cn
Received: January 23, 2022
Peer-review started: January 23, 2022
First decision: March 24, 2022
Revised: April 6, 2022
Accepted: May 17, 2022
Article in press: May 17, 2022
Published online: July 16, 2022
Processing time: 162 Days and 14.4 Hours
Abstract
BACKGROUND

Major adverse cardiac events (MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.

AIM

To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.

METHODS

The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.

RESULTS

In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-I (Hs-TnI), creatine kinase isoenzyme (CK-MB), myoglobin (MYO), B-type natriuretic peptide (BNP), and D-dimer (D-D) levels were significantly increased (P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic (ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.

CONCLUSION

The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.

Keywords: Biliary diseases in elderly patients; Major adverse cardiac events; Perioperative safety; Logistic regression; Receiver operating characteristic curve

Core Tip: This study focused on high-risk elderly patients with biliary diseases, and determined the monitoring indexes of perioperative major adverse cardiac events (MACE) by a logistic multivariate prediction model. It was found that postoperative BNP and D-dimer (D-D) were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L, respectively. Therefore, timely monitoring, effective prevention and treatment measures are of great clinical significance to maintain the stability of perioperative cardiac function, and further improve the perioperative safety of elderly patients with biliary diseases.