当前位置:科学网首页 > 小柯机器人 >详情
25万患者肌钙蛋白水平和年龄与死亡率的关系
作者:小柯机器人 发布时间:2019/11/24 14:04:23

近日,英国哈默史密斯医院教授Jamil Mayet及其小组研究了25万名患者肌钙蛋白水平和年龄与死亡率的关系。该项研究成果发表在2019年11月21日出版的《英国医学杂志》上。

2010-2017年间,研究组在英国国家健康研究所健康信息学协作组织(UK-NIHR HIC)内设立了五个心血管中心,招募了257948名接受肌钙蛋白测试的患者。使用峰值肌钙蛋白水平对肌钙蛋白进行分析,即患者住院期间测得的最高肌钙蛋白水平。

肌钙蛋白水平被标准化为每个实验室正常上限(ULN)的99%。在中位随访1198天后,有55850人(21.7%)死亡。肌钙蛋白阳性(高于正常值上限)意味着3年内的死亡风险增加3.2。死亡率随年龄变化显著,18-29岁的风险比为10.6,90岁以上的风险比为1.5。肌钙蛋白阳性导致所有年龄组的绝对三年死亡率增加了大约15个百分点。肌钙蛋白阳性的超额死亡在最初几周集中出现。

肌钙蛋白水平与没有急性冠脉综合征(ACS,120049例)患者的死亡率呈直接正相关,而与ACS(14468例)患者呈倒U型关系,峰值肌钙蛋白水平高于70倍ULN的死亡率呈下降趋势。ACS组经多变量调整后,侵入性治疗组仍保持倒U型关系;非侵入性治疗组则呈直接正相关。

总之,肌钙蛋白阳性与临床重大死亡率增加有关,哪怕是仅略高于正常水平,却与年龄无关。肌钙蛋白升高导致的超额死亡在最初几周内高度集中。

附:英文原文

Title: Association of troponin level and age with mortality in 250000 patients: cohort study across five UK acute care centres

Author: Amit Kaura, Vasileios Panoulas, Benjamin Glampson, Jim Davies, Abdulrahim Mulla, Kerrie Woods, Joe Omigie, Anoop D Shah, Keith M Channon, Jonathan N Weber, Mark R Thursz, Paul Elliott, Harry Hemingway, Bryan Williams, Folkert Asselbergs, Michael O’Sullivan, Rajesh Kharbanda, Graham M Lord, Narbeh Melikian, Riyaz S Patel, Divaka Perera, Ajay M Shah, Darrel P Francis, Jamil Mayet

Issue&Volume: 2019/11/21

Abstract:

Objective To determine the relation between age and troponin level and its prognostic implication.

Design Retrospective cohort study.

Setting Five cardiovascular centres in the UK National Institute for Health Research Health Informatics Collaborative (UK-NIHR HIC).

Participants 257 948 consecutive patients undergoing troponin testing for any clinical reason between 2010 and 2017.

Main outcome measure All cause mortality.

Results 257 948 patients had troponin measured during the study period. Analyses on troponin were performed using the peak troponin level, which was the highest troponin level measured during the patient’s hospital stay. Troponin levels were standardised as a multiple of each laboratory’s 99th centile of the upper limit of normal (ULN). During a median follow-up of 1198 days (interquartile range 514-1866 days), 55 850 (21.7%) deaths occurred. A positive troponin result (that is, higher than the upper limit of normal) signified a 3.2 higher mortality hazard (95% confidence interval 3.1 to 3.2) over three years. Mortality varied noticeably with age, with a hazard ratio of 10.6 (8.5 to 13.3) in 18-29 year olds and 1.5 (1.4 to 1.6) in those older than 90. A positive troponin result was associated with an approximately 15 percentage points higher absolute three year mortality across all age groups. The excess mortality with a positive troponin result was heavily concentrated in the first few weeks. Results were analysed using multivariable adjusted restricted cubic spline Cox regression. A direct relation was seen between troponin level and mortality in patients without acute coronary syndrome (ACS, n=120 049), whereas an inverted U shaped relation was found in patients with ACS (n=14 468), with a paradoxical decline in mortality at peak troponin levels >70×ULN. In the group with ACS, the inverted U shaped relation persisted after multivariable adjustment in those who were managed invasively; however, a direct positive relation was found between troponin level and mortality in patients managed non-invasively.

Conclusions A positive troponin result was associated with a clinically important increased mortality, regardless of age, even if the level was only slightly above normal. The excess mortality with a raised troponin was heavily concentrated in the first few weeks.

DOI: 10.1136/bmj.l6055

Source: https://www.bmj.com/content/367/bmj.l6055

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj