Immature platelets as a novel biomarker for adverse cardiovascular events in patients after non-cardiac surgery

Aida Anetsberger; Manfred Blobner; Bernhard Haller; Sebastian Schmid; Katrin Umgelter; Theresa Hager; Clemens Langgartner; Eberhard F. Kochs; Karl-Ludwig Laugwitz; Bettina Jungwirth; Isabell Bernlochner

doi:10.1160/TH16-10-0804

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2017; 117(10): 1887-1895
DOI: 10.1160/TH16-10-0804

Cellular Haemostasis and Platelets

Schattauer GmbH

Immature platelets as a novel biomarker for adverse cardiovascular events in patients after non-cardiac surgery

Aida Anetsberger

¹Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Manfred Blobner

¹Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Bernhard Haller

²Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Sebastian Schmid

¹Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Katrin Umgelter

¹Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Theresa Hager

¹Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Clemens Langgartner

¹Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Eberhard F. Kochs

¹Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Karl-Ludwig Laugwitz

³I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Bettina Jungwirth

¹Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

,

Isabell Bernlochner

³I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

› Author Affiliations

Abstract

Summary

This study evaluates whether immature platelets (IPF) determined in the post anesthesia care unit (PACU) can predict major adverse cardiovascular events (MACE) or other thromboembolic events after intermediate and high-risk surgery. IPF are increased in patients with acute coronary syndrome and recently gained interest as novel biomarker for risk stratification. In this prospective observational trial 732 patients undergoing intermediate or high-risk non-cardiac surgery were enrolled (NCT02097602). IPF was measured preoperatively and postoperatively in the PACU. Primary outcome was a composite endpoint defined as MACE, deep vein thrombosis or pulmonary embolism during hospital stay (modMACE). A cut off for IPF identifying a threshold between a low and high risk for modMACE was calculated by logrank optimization. A multivariate Cox regression was calculated in a forward stepwise manner to assess the relation between this IPF cut off and modMACE as well as other established risk factors (inclusion if p<0.05). Preoperatively, there were no differences in IPF between patients with and without modMACE (3.1% [2.2% – 4.7%](median [interquartile range]) vs. 2.8% [1.9% – 4.3%]. Patients with modMACE (28 of 730 patients; 3.8%) had higher IPF values in the PACU compared to patients without modMACE (3.6% [2.6–6%] vs. 2.9% [2–4.4%]; p=0.011). The optimal cut off of IPF > 5.4% was associated with an increased risk for modMACE after adjustment for covariates (hazard ratio: 2.528; 95% confidence interval: 1.156 to 5.528, p=0.02). In conclusion, IPF is an independent predictor of modMACE after surgery and might improve risk stratification of surgical patients.

Institution where the work was performed and funded: Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675 Munich, Germany.

Keywords

Reticulated platelets - immature platelet fraction - non-cardiac surgery - major adverse events - thrombotic events

Full Text

References

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