Ann Lab Med 2018; 38(3): 204-211  https://doi.org/10.3343/alm.2018.38.3.204
Prognostic Role of High-sensitivity Cardiac Troponin I and Soluble Suppression of Tumorigenicity-2 in Surgical Intensive Care Unit Patients Undergoing Non-cardiac Surgery
Hyun Suk Yang, M.D.1, Mina Hur, M.D.2, Ahram Yi, M.D.2, Hanah Kim, M.D.2, and Jayoun Kim, Ph.D.3
Departments of Cardiovascular Medicine1 and Laboratory Medicine2, Konkuk University School of Medicine, Seoul; Research Coordinating Center3, Konkuk University Medical Center, Seoul, Korea
Corresponding author: Mina Hur
Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul 05030, Korea
Tel: +82-2-2030-5581
Fax: +82-2-2636-6764
E-mail: dearmina@hanmail.net
Received: September 23, 2017; Revised: November 29, 2017; Accepted: December 26, 2017; Published online: May 1, 2018.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The prognostic utility of cardiac biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and soluble suppression of tumorigenicity-2 (sST2), in non-cardiac surgery is not well-defined. We evaluated hs-cTnI and sST2 as predictors of 30-day major adverse cardiac events (MACE) in patients admitted to the surgical intensive care unit (SICU) following major non-cardiac surgery.
Methods: hs-cTnI and sST2 concentrations were measured in 175 SICU patients immediately following surgery and for three days postoperatively. The results were analyzed in relation to 30-day MACE and were compared with the revised Goldman cardiac risk index (RCRI) score.
Results: Overall, 30-day MACE was observed in 16 (9.1%) patients. hs-cTnI and sST2 concentrations differed significantly between the two groups with and without 30-day MACE (P <0.05). The maximum concentration of sST2 was an independent predictor of 30-day MACE (odds ratio=1.016, P =0.008). The optimal cut-off values of hs-cTnI and sST2 for predicting 30-day MACE were 53.0 ng/L and 182.5 ng/mL, respectively. A combination of hs-cTnI and sST2 predicted 30-day MACE better than the RCRI score. Moreover, 30-day MACE was observed more frequently with increasing numbers of above-optimal cut-off hs-cTnI and sST2 values (P <0.0001). Reclassification analyses indicated that the addition of biomarkers to RCRI scores improved the prediction of 30-day MACE.
Conclusions: This study demonstrates the utility of hs-cTnI and sST2 in predicting 30-day MACE following non-cardiac surgery. Cardiac biomarkers would provide enhanced risk stratification in addition to clinical RCRI scores for patients undergoing major non-cardiac surgery.
Keywords: High-sensitivity cardiac troponin I, Soluble suppression of tumorigenicity-2, Non-cardiac surgery, Prognosis



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