Troponin I Level and Mortality in Acute Abdominal Surgery

Study Overview
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Brief Summary
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The goal of this prospective cohort study is to estimate the incidence of myocardial injury after non-cardiac surgery (MINS) in patients undergoing acute high-risk abdominal surgery. MINS is defined as at least one increased single measurement of plasma troponin I (TnI). TnI-dynamic is defined as either two succeeding measurements of TnI > 59 ng/l with an increase/fall of more than 20%, or by one measurements of TnI > 59 ng/l with a succeeding measurement of TnI < 59 ng/l and a decrease of more than 50%. Participants will have plasma TnI measured 6-12 hours postoperatively and on each of the following four postoperative days. Follow-up will be minimum one year after surgery. The aim of the study is to determine: The incidence of MINS within the first four postoperative days The incidence of dynamic TnI changes The association between MINS and dynamic TnI changes respectively and all-course short-term mortality

Detailed Description
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Gastrointestinal tract perforation, bowel ischemia and bowel obstruction are considered acute high-risk abdominal disorders, often requiring emergency surgery. Myocardial injury after non-cardiac surgery (MINS) is a frequent but often unrecognized postoperative complication. MINS is associated with an increased risk of other cardiac complications and 30-day mortality. However, the literature on MINS is mainly regarding patients undergoing a wide range of elective or acute surgical procedures, and we do not know if the dynamic TnI-criteria used for acute myocardial injury has any association with mortality in patients with MINS. This study aims to estimate the incidence of MINS in patients undergoing AHA surgery, and the association between the short-term mortality and MINS defined as a single increased measurement of TnI and as TnI dynamics respectively.

Official Title
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Association Between Troponin I Levels and Mortality Among Patients Undergoing Acute High-risk Abdominal Surgery - a Cohort Study

Conditions
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Myocardial Injury After Non-cardiac Surgery, Abdomen, Acute

Intervention / Treatment
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* Diagnostic Test: Troponin I


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years or older Patients undergoing acute high-risk abdominal surgery Exclusion Criteria: Patients with microscopic perforations in colonic diverticulitis managed with laparoscopic lavage or drainage If further treatment postoperatively was assessed as futile and terminated immediately after surgery

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with MINS<br>Troponin I level equal to or above 59 ng/L | Diagnostic Test: Troponin I<br>* Measurements of plasma Troponin I 6-12 hours and on the first four postoperative days after surgery.<br>|
| Patients without MINS<br>Troponin I level under 59 ng/L | Diagnostic Test: Troponin I<br>* Measurements of plasma Troponin I 6-12 hours and on the first four postoperative days after surgery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of MINS within the first four postoperative days | Postoperative troponin I level equal to or above 59 ng/L | The first four postoperative days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of dynamic plasma Troponin I changes | Patients with postoperative troponin I level equal to or above 59 ng/L and a change of +20% | The first four postoperative days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Myocardial injury after non-cardiac surgery, Abdomen, Acute, Troponin I, Myocardial Injury, Emergency surgery