Background High body mass index （BMI） is a risk factor for chronic cardiac disease. However, mounting evidence supports that high BMI is associated with less risk of cardiac morbidity and mortality compared with nor...Background High body mass index （BMI） is a risk factor for chronic cardiac disease. However, mounting evidence supports that high BMI is associated with less risk of cardiac morbidity and mortality compared with normal BMI, also known as the obesity paradox. There- fore, we sought to determine the existence of the obesity paradox in regard to perioperative 30-day cardiac events among elderly Chinese patients with known coronary artery disease undergoing non-cardiac surgery. Methods A post-hoc analysis of a prospective, multi-institutional cohort study was performed. Patients aged 〉 60 years with a history of coronary artery disease and undergoing non-cardiac surgery were grouped according to BMI： underweight （〈 18.5 kg/m2）, normal weight （18.5-24.9 kg/m2）, overweight （25-29.9 kg/m2） and obese （≥ 30 kg/m2）. Demographic information, perioperative clinical variables and incidence of 30-day postoperative cardiac adverse event were retrieved from a research database. Results We identified 1202 eligible patients （BMI： 24.3 ± 3.8 kg/m2）. Across BMI groups, a U-shaped distribution pattern of incidence of 30-day postoperative major cardiac events was observed, with the lowest risk in the overweight group. When using the normal-weight group as a reference, no difference was found in either the obesity or overweight groups in terms of a major cardiac adverse event （MACE）. However, risk of a 30-day postoperative MACE was significantly higher in the underweight group （odds ratio [OR] 2.916, 95% confidence interval [CI]： 1.072-7.931, P = 0.036）. Conclusion Although not statistically significant, the U-shaped relation between BMI and cardiac complications indicates the obesity paradox possibly exists.展开更多
BACKGROUND High-sensitivity cardiac troponin(hs-cTn)levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events.However,most studies on the role of elevated hs-cTn ...BACKGROUND High-sensitivity cardiac troponin(hs-cTn)levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events.However,most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.METHODS In this retrospective study,we selected patients who were aged≥65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons.Eligible patients were those who had hs-cTnI concentrations≥100 ng/L.We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.RESULTS One hundred and forty-six patients(59%female)were selected with an age range from 65 to 100(mean±SD:85.4±7.61)years.The median hs-cTnI value was 284.2 ng/L.For 72(49%)patients the diagnosis of hospitalization was an infectious disease.The overall in-hospital mortality was 32%(47 patients).Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive(median:314.8 vs 282.5 ng/L;P=0.565).There was no difference in mortality in patients with infectious vs non-infectious disease(29%vs 35%).Multivariable analysis showed that age(OR 1.062 per 1 year increase,95%CI:1.000-1.127;P=0.048)and creatinine levels(OR 2.065 per 1 mg/dL increase,95%CI:1.383-3.085;P<0.001)were the only independent predictors of death.Mortality was 49%in patients with eGFR<30 mL/min/1.73 m2.CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons.The presence of severe renal impairment is a marker of extremely high in-hospital mortality.展开更多
The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertio...The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.展开更多
Background:Despite the growing epidemic of heart failure(HF),there is limited data available to systematically compare noncardiac comorbidities in the young-old,old-old,and oldest-old patients hospitalized for HF.The ...Background:Despite the growing epidemic of heart failure(HF),there is limited data available to systematically compare noncardiac comorbidities in the young-old,old-old,and oldest-old patients hospitalized for HF.The precise differences will add valuable information for better management of HF in elderly patients.Methods:A total of 1053 patients aged 65 years or older hospitalized with HF were included in this study.Patients were compared among three age groups:(1)young-old:65 to 74 years,(2)old-old:75 to 84 years,and(3)oldest-old:≥85 years.Clinical details of presentation,comorbidities,and prescribed medications were recorded.Results:The mean age was 76.7 years and 12.7%were 85 years or older.Most elderly patients with HF(97.5%)had at least one of the non-cardiac comorbidities.The patterns of common non-cardiac comorbidities were different between the young-old and oldestold group.The three most common non-cardiac comorbidities were anemia(53.6%),hyperlipidemia(45.9%),and diabetes(42.4%)in the young-old group,while anemia(73.1%),infection(58.2%),and chronic kidney disease(44.0%)in the oldest-old group.Polypharmacy was observed in 93.0%elderly patients with HF.Additionally,29.2%patients were diagnosed with infection,and 67.0%patients were prescribed antibiotics.However,60.4%patients were diagnosed with anemia with only 8.9%of them receiving iron repletion.Conclusions:Non-cardiac comorbidities are nearly universal in three groups but obviously differ by age,and inappropriate medications are very common in elderly patients with HF.Further treatment strategies should be focused on providing optimal medications for age-specific non-cardiac conditions.展开更多
Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The p...Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.Methods:This study was a secondary analysis of a prospective observational study.Taking baseline body temperature as a reference,intraoperative absolute and relative temperature changes were calculated.The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference.ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.Results:A total of 874 patients were analyzed with a mean age of 71.8±5.3 years.The incidence of ED was 38.4%(336/874).When taking 36.0°C,35.5°C,and 35.0°C as thresholds,the incidences of absolute hypothermia were 76.7%(670/874),38.4%(336/874),and 17.5%(153/874),respectively.In multivariable logistic regression analysis,absolute hypothermia(lowest value<35.5°C)and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age,education,preoperative mild cognitive impairment,American Society of Anesthesiologists grade,duration of surgery,site of surgery,and pain intensity.Relative hypothermia(decrement>1.0°C from baseline)and its cumulative duration were also associated with an increased risk of ED,respectively.When taking the relative increment>0.5°C as a threshold,the incidence of relative hyperthermia was 21.7%(190/874)and it was associated with a decreased risk of ED after adjusting above confounders.Conclusions:In the present study,we found that intraoperative hypothermia,defined as either absolute or relative hypothermia,was associated with an increased risk of ED in elderly patients after non-cardiac surgery.Relative hyperthermia,but not absolute hyperthermia,was associated with a decreased risk of ED.Registration:Chinese Clinical Trial Registry(No.ChiCTR-OOC-17012734).展开更多
Background:Post-operative acute kidney injury(AKI)is one of the most common and serious complications after major surgery and is significantly associated with increased risks of morbidity and mortality.This meta-analy...Background:Post-operative acute kidney injury(AKI)is one of the most common and serious complications after major surgery and is significantly associated with increased risks of morbidity and mortality.This meta-analysis was conducted to evaluate the effects of perioperative dexmedetomidine(Dex)administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.Methods:The PubMed,Embase,Web of Science,and Cochrane Library databases were systematically searched for studies comparing the effects of Dexvs.placebo on kidney function after non-cardiac surgery,and a pooled fixed-effect meta-analysis of the included studies was performed.The primary outcome was the occurence of post-operative AKI.The secondary outcomes included the occurence of intra-operative hypotension and bradycardia,intensive care unit(ICU)admission,duration of ICU stay,and hospital length of stay(LOS).Results:Six studies,including four randomized controlled trials(RCTs)and two observational studies,with a total of 2586 patients were selected.Compared with placebo,Dex administration could not reduce the odds of post-operative AKI(odds ratio[OR],0.44;95%confidence interval(CI),0.18-1.06;P=0.07;I^(2)=0.00%,P=0.72)in RCTs,but it showed a significant renoprotective effect(OR,0.67;95%CI,0.48-0.95;P=0.02;I^(2)=0.00%,P=0.36)in observational studies.Besides,Dex administration significantly increased the odds of intra-operative bradycardia and shortened the duration of ICU stay.However,there was no significant difference in the odds of intra-operative hypotension,ICU admission,and hospital LOS.Conclusions:This meta-analysis suggests that perioperative Dex administration does not reduce the risk of AKI after non-cardiac surgery.However,the quality of evidence for this result is low due to imprecision and inconsistent types of non-cardiac operations.Thus,large and high-quality RCTs are needed to verify the real effects of perioperative Dex administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.展开更多
Objectives To measure circulating B-type natriuretic peptide （BNP） levels in patients with heart disease undergoing elective major non-cardiac surgery and to explore the relationship between the changes in BNP level...Objectives To measure circulating B-type natriuretic peptide （BNP） levels in patients with heart disease undergoing elective major non-cardiac surgery and to explore the relationship between the changes in BNP level and cardiac events after surgical intervention. Methods Subjects comprised 232 patients with heart disease undergoing elective major non- cardiac surgery. Patients were classified into two groups based on BNP concentrations before surgery： those with BNP plasma levels ≤ 100 pg/mL （ Group A, n = 170） ; and those with BNP plasma levels 〉 100 pg/mL （ Group B, n = 62 ）. Preoperative BNP sampling was undertaken 24h before surgery, and postoperative 2 h after surgery. Screening for cardiac events was performed using clinical criteria, cardiac tropnin I analysis and serial electrocardiography. Results There was no significant difference in BNP concentrations between before surgery （73.5 ± 20. 6） pg/mL and after non- cardiac surgery （69.3 ± 27.5 ） pg/mL in group A （P 〉 0. 05 ）, while there was a significant difference in BNP concentrations between before surgery （ 149.3 ± 73.5 ） pg/mL and after non-cardiac surgery （ 341.5 ± 162. 4 ） pg/mL in group B （P 〈 0. 001 ）. Patients with postoperative cardiac events had significantly higher BNP levels （207.3 ± 99. 1 ） pg/mL before and （416. 9 ± 202. 8） pg/mL after non-cardiac surgery than those in patients with no cardiac events in group B. There was a significant difference in cardiac events between group A, in which no patient had cardiac events, and group B, in which 15 patients had cardiac events （ P 〈 0. 001 ）. Conclusions The changes in BNP levels after non- cardiac surgery were influenced by the preoperative levels of BNP, and relative to cardiac events.展开更多
文摘Background High body mass index （BMI） is a risk factor for chronic cardiac disease. However, mounting evidence supports that high BMI is associated with less risk of cardiac morbidity and mortality compared with normal BMI, also known as the obesity paradox. There- fore, we sought to determine the existence of the obesity paradox in regard to perioperative 30-day cardiac events among elderly Chinese patients with known coronary artery disease undergoing non-cardiac surgery. Methods A post-hoc analysis of a prospective, multi-institutional cohort study was performed. Patients aged 〉 60 years with a history of coronary artery disease and undergoing non-cardiac surgery were grouped according to BMI： underweight （〈 18.5 kg/m2）, normal weight （18.5-24.9 kg/m2）, overweight （25-29.9 kg/m2） and obese （≥ 30 kg/m2）. Demographic information, perioperative clinical variables and incidence of 30-day postoperative cardiac adverse event were retrieved from a research database. Results We identified 1202 eligible patients （BMI： 24.3 ± 3.8 kg/m2）. Across BMI groups, a U-shaped distribution pattern of incidence of 30-day postoperative major cardiac events was observed, with the lowest risk in the overweight group. When using the normal-weight group as a reference, no difference was found in either the obesity or overweight groups in terms of a major cardiac adverse event （MACE）. However, risk of a 30-day postoperative MACE was significantly higher in the underweight group （odds ratio [OR] 2.916, 95% confidence interval [CI]： 1.072-7.931, P = 0.036）. Conclusion Although not statistically significant, the U-shaped relation between BMI and cardiac complications indicates the obesity paradox possibly exists.
文摘BACKGROUND High-sensitivity cardiac troponin(hs-cTn)levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events.However,most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.METHODS In this retrospective study,we selected patients who were aged≥65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons.Eligible patients were those who had hs-cTnI concentrations≥100 ng/L.We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.RESULTS One hundred and forty-six patients(59%female)were selected with an age range from 65 to 100(mean±SD:85.4±7.61)years.The median hs-cTnI value was 284.2 ng/L.For 72(49%)patients the diagnosis of hospitalization was an infectious disease.The overall in-hospital mortality was 32%(47 patients).Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive(median:314.8 vs 282.5 ng/L;P=0.565).There was no difference in mortality in patients with infectious vs non-infectious disease(29%vs 35%).Multivariable analysis showed that age(OR 1.062 per 1 year increase,95%CI:1.000-1.127;P=0.048)and creatinine levels(OR 2.065 per 1 mg/dL increase,95%CI:1.383-3.085;P<0.001)were the only independent predictors of death.Mortality was 49%in patients with eGFR<30 mL/min/1.73 m2.CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons.The presence of severe renal impairment is a marker of extremely high in-hospital mortality.
文摘The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.
基金This work was supported by the National Natural Science Foundation of China(81770359 and 81270276)Central Health Research Project of China(W2017BJ30)+1 种基金State Key Laboratory of Molecular Developmental Biology of China(2017-MDB-KF-13)to Jingyi RenChina-Japan Friendship Hospital Scientific Research Funds(2017-1-QN-10)to Mengxi Yang.
文摘Background:Despite the growing epidemic of heart failure(HF),there is limited data available to systematically compare noncardiac comorbidities in the young-old,old-old,and oldest-old patients hospitalized for HF.The precise differences will add valuable information for better management of HF in elderly patients.Methods:A total of 1053 patients aged 65 years or older hospitalized with HF were included in this study.Patients were compared among three age groups:(1)young-old:65 to 74 years,(2)old-old:75 to 84 years,and(3)oldest-old:≥85 years.Clinical details of presentation,comorbidities,and prescribed medications were recorded.Results:The mean age was 76.7 years and 12.7%were 85 years or older.Most elderly patients with HF(97.5%)had at least one of the non-cardiac comorbidities.The patterns of common non-cardiac comorbidities were different between the young-old and oldestold group.The three most common non-cardiac comorbidities were anemia(53.6%),hyperlipidemia(45.9%),and diabetes(42.4%)in the young-old group,while anemia(73.1%),infection(58.2%),and chronic kidney disease(44.0%)in the oldest-old group.Polypharmacy was observed in 93.0%elderly patients with HF.Additionally,29.2%patients were diagnosed with infection,and 67.0%patients were prescribed antibiotics.However,60.4%patients were diagnosed with anemia with only 8.9%of them receiving iron repletion.Conclusions:Non-cardiac comorbidities are nearly universal in three groups but obviously differ by age,and inappropriate medications are very common in elderly patients with HF.Further treatment strategies should be focused on providing optimal medications for age-specific non-cardiac conditions.
基金supported by a grant from the National Key Research and Development Program of China(No.2018YFC2001800)
文摘Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.Methods:This study was a secondary analysis of a prospective observational study.Taking baseline body temperature as a reference,intraoperative absolute and relative temperature changes were calculated.The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference.ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.Results:A total of 874 patients were analyzed with a mean age of 71.8±5.3 years.The incidence of ED was 38.4%(336/874).When taking 36.0°C,35.5°C,and 35.0°C as thresholds,the incidences of absolute hypothermia were 76.7%(670/874),38.4%(336/874),and 17.5%(153/874),respectively.In multivariable logistic regression analysis,absolute hypothermia(lowest value<35.5°C)and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age,education,preoperative mild cognitive impairment,American Society of Anesthesiologists grade,duration of surgery,site of surgery,and pain intensity.Relative hypothermia(decrement>1.0°C from baseline)and its cumulative duration were also associated with an increased risk of ED,respectively.When taking the relative increment>0.5°C as a threshold,the incidence of relative hyperthermia was 21.7%(190/874)and it was associated with a decreased risk of ED after adjusting above confounders.Conclusions:In the present study,we found that intraoperative hypothermia,defined as either absolute or relative hypothermia,was associated with an increased risk of ED in elderly patients after non-cardiac surgery.Relative hyperthermia,but not absolute hyperthermia,was associated with a decreased risk of ED.Registration:Chinese Clinical Trial Registry(No.ChiCTR-OOC-17012734).
基金National Natural Science Foundation of China(No.81470019)。
文摘Background:Post-operative acute kidney injury(AKI)is one of the most common and serious complications after major surgery and is significantly associated with increased risks of morbidity and mortality.This meta-analysis was conducted to evaluate the effects of perioperative dexmedetomidine(Dex)administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.Methods:The PubMed,Embase,Web of Science,and Cochrane Library databases were systematically searched for studies comparing the effects of Dexvs.placebo on kidney function after non-cardiac surgery,and a pooled fixed-effect meta-analysis of the included studies was performed.The primary outcome was the occurence of post-operative AKI.The secondary outcomes included the occurence of intra-operative hypotension and bradycardia,intensive care unit(ICU)admission,duration of ICU stay,and hospital length of stay(LOS).Results:Six studies,including four randomized controlled trials(RCTs)and two observational studies,with a total of 2586 patients were selected.Compared with placebo,Dex administration could not reduce the odds of post-operative AKI(odds ratio[OR],0.44;95%confidence interval(CI),0.18-1.06;P=0.07;I^(2)=0.00%,P=0.72)in RCTs,but it showed a significant renoprotective effect(OR,0.67;95%CI,0.48-0.95;P=0.02;I^(2)=0.00%,P=0.36)in observational studies.Besides,Dex administration significantly increased the odds of intra-operative bradycardia and shortened the duration of ICU stay.However,there was no significant difference in the odds of intra-operative hypotension,ICU admission,and hospital LOS.Conclusions:This meta-analysis suggests that perioperative Dex administration does not reduce the risk of AKI after non-cardiac surgery.However,the quality of evidence for this result is low due to imprecision and inconsistent types of non-cardiac operations.Thus,large and high-quality RCTs are needed to verify the real effects of perioperative Dex administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.
基金supported by Research Foundation of the Second Affiliated Hospital of Chinese PLA General Hospital
文摘Objectives To measure circulating B-type natriuretic peptide （BNP） levels in patients with heart disease undergoing elective major non-cardiac surgery and to explore the relationship between the changes in BNP level and cardiac events after surgical intervention. Methods Subjects comprised 232 patients with heart disease undergoing elective major non- cardiac surgery. Patients were classified into two groups based on BNP concentrations before surgery： those with BNP plasma levels ≤ 100 pg/mL （ Group A, n = 170） ; and those with BNP plasma levels 〉 100 pg/mL （ Group B, n = 62 ）. Preoperative BNP sampling was undertaken 24h before surgery, and postoperative 2 h after surgery. Screening for cardiac events was performed using clinical criteria, cardiac tropnin I analysis and serial electrocardiography. Results There was no significant difference in BNP concentrations between before surgery （73.5 ± 20. 6） pg/mL and after non- cardiac surgery （69.3 ± 27.5 ） pg/mL in group A （P 〉 0. 05 ）, while there was a significant difference in BNP concentrations between before surgery （ 149.3 ± 73.5 ） pg/mL and after non-cardiac surgery （ 341.5 ± 162. 4 ） pg/mL in group B （P 〈 0. 001 ）. Patients with postoperative cardiac events had significantly higher BNP levels （207.3 ± 99. 1 ） pg/mL before and （416. 9 ± 202. 8） pg/mL after non-cardiac surgery than those in patients with no cardiac events in group B. There was a significant difference in cardiac events between group A, in which no patient had cardiac events, and group B, in which 15 patients had cardiac events （ P 〈 0. 001 ）. Conclusions The changes in BNP levels after non- cardiac surgery were influenced by the preoperative levels of BNP, and relative to cardiac events.
