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ISRN Vascular Medicine
Volume 2011 (2011), Article ID 403130, 5 pages
http://dx.doi.org/10.5402/2011/403130
Clinical Study

Risk Stratification by Cardiac Biomarkers following Emergency Gastrointestinal Surgery

1Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
2Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
3Department of Biochemistry, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK

Received 7 July 2011; Accepted 20 September 2011

Academic Editor: M. Shechter

Copyright © 2011 T. J. Cahill et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Perioperative cardiac complications are a major cause of death following emergency gastrointestinal surgery. Early diagnosis of subclinical myocardial injury and infarction may be improved by screening with cardiac biomarkers. The aim of this study was to assess the predictive value of troponin I (TnI) and B-type natriuretic peptide (BNP) in the early postoperative period after emergency gastrointestinal surgery. We prospectively recruited 48 patients undergoing major emergency surgery for gastrointestinal or colorectal pathology in a single district general hospital. The primary endpoint was mortality at 90 days following surgery. Overall survival was 81.3% (39/48), with 9 postoperative deaths. Elevated TnI (≥0.03 ng  m L โˆ’ 1 ) was the best predictor of mortality, associated with an odds ratio of death by 90 days of 14.3 (95% CI 1.50–337, ๐‘ƒ = 0 . 0 1 ). A postoperative BNP concentration >408.5 pg  m L โˆ’ 1 was associated with an odds ratio of death by 90 days of 13.6 (95% CI 2.03–106, ๐‘ƒ = 0 . 0 0 2 ). A single measurement of postoperative BNP and TnI is a powerful predictor of short- to medium-term mortality in patients after emergency gastrointestinal surgery. Further work is required to demonstrate that cardiac biomarkers have independent predictive power and that patient outcomes can be improved.