Prognostic value of perioperative assessment of plasma cardiac troponin I in patients undergoing liver transplantation

Abstract

An elevation in plasma cardiac troponin is an indicator of increased perioperative risk in orthopaedic and vascular surgery, however data on liver transplantation (LTx) are scarce.The aim of the study was to evaluate the prevalence of cardiac troponin I (cTnI) elevation in the perioperative period of LTx, and its potential relationship with 1-year mortality.Material and methods.  Analysis included 79 patients with liver cirrhosis.  During LTx all patients underwent hemodynamic measurements. cTnI was determined before the operation, 24, 48 and 72 hours afterwards.  One-year mortality was assessed.Results. 12.7% patients died, all during in-hospital period.  cTnI on day 1. was identified as the most promising marker of increased death risk with optimal cut-off value of 0.215 ng/ml (the sensitivity of  60.0%, specificity of  87.0%, positive predictive value of 40.0%, negative predictive value of 93.8%).The most important predictor of cTnI increase was the duration of the LTx procedure followed by packed red blood cells transfused, basic stroke volume index, and cardiac output index.In conclusion:  value of cTnI assessed 24 hours post-surgery was a reliable predictor of death following LTx with optimal cut-off value of 0.215ng/ml. The surgery time was the most important predictor of cTnI elevation.