Ted Reniers , Thijs Rettig , Laura van Zeggeren , Ineke Dijkstra , Kyra Prinsze , Izaak Molenaar , Hjalmar van Santvoort , Olaf Cremer , Lisette Vernooij , Peter Noordzij
{"title":"Is chronic inflammation a risk factor for perioperative myocardial injury or heart failure in pancreatic surgery patients?","authors":"Ted Reniers , Thijs Rettig , Laura van Zeggeren , Ineke Dijkstra , Kyra Prinsze , Izaak Molenaar , Hjalmar van Santvoort , Olaf Cremer , Lisette Vernooij , Peter Noordzij","doi":"10.1016/j.bjao.2025.100417","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Chronic inflammation is associated with cardiovascular disease. Whether cardiac risk is increased in surgical patients with chronic inflammation is unknown. We hypothesised that preoperative interleukin 6 (IL-6) is associated with postoperative biomarker release indicative of myocardial injury and heart failure.</div></div><div><h3>Methods</h3><div>In this prospective cohort study in pancreatic surgery patients, concentrations of IL-6, high-sensitive cardiac troponin-T (hs-cTnT), growth differentiation factor 15 (GDF-15), and N-terminal pro B-type natriuretic peptide (NT-proBNP) were assessed before surgery and 4, 12, 24, and 48 h after surgery. The primary outcome was perioperative myocardial injury (PMI), defined as an absolute hs-cTnT increase ≥14 pg ml<sup>−1</sup>. Secondary outcomes were postoperative concentrations of GDF-15 and NT-proBNP. We used the χ<sup>2</sup> test and generalised linear mixed effects models for analyses.</div></div><div><h3>Results</h3><div>Of 88 patients, 24 (27%) had high preoperative IL-6 (>7 pg ml<sup>−1</sup>). PMI occurred in two (8.3%) and eight (12.5%) patients with high and normal concentrations, respectively (<em>P</em>=0.86). Patients with high IL-6 had higher preoperative concentrations of hs-cTnT (11.0 [inter-quartile range 7.0–15.0] <em>vs</em> 8.0 [5.0–11.0] pg ml<sup>−1</sup>, <em>P</em>=0.01), GDF-15 (1924.5 [1403.8–2797.5] <em>vs</em> 1445.0 pg ml<sup>−1</sup> [1006.5–1905.3] pg ml<sup>−1</sup>, <em>P</em>=0.021) and NT-proBNP (279.5 [128.8–569.0] <em>vs</em> 116.5 [65.1–226.5] pg ml<sup>−1</sup>, <em>P</em>=0.012). All biomarkers increased after surgery (all <em>P</em><0.05), yet this increase was similar among patients with high or normal preoperative IL-6 concentrations.</div></div><div><h3>Conclusions</h3><div>Preoperative inflammation was not associated with PMI or postoperative biomarkers of heart failure after pancreatic surgery. However, patients with high IL-6 concentrations had higher preoperative concentrations of cardiac biomarkers, suggesting the presence of subclinical cardiovascular disease.</div></div><div><h3>Clinical trial registration</h3><div>NCT03460938.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100417"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJA open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772609625000413","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Chronic inflammation is associated with cardiovascular disease. Whether cardiac risk is increased in surgical patients with chronic inflammation is unknown. We hypothesised that preoperative interleukin 6 (IL-6) is associated with postoperative biomarker release indicative of myocardial injury and heart failure.
Methods
In this prospective cohort study in pancreatic surgery patients, concentrations of IL-6, high-sensitive cardiac troponin-T (hs-cTnT), growth differentiation factor 15 (GDF-15), and N-terminal pro B-type natriuretic peptide (NT-proBNP) were assessed before surgery and 4, 12, 24, and 48 h after surgery. The primary outcome was perioperative myocardial injury (PMI), defined as an absolute hs-cTnT increase ≥14 pg ml−1. Secondary outcomes were postoperative concentrations of GDF-15 and NT-proBNP. We used the χ2 test and generalised linear mixed effects models for analyses.
Results
Of 88 patients, 24 (27%) had high preoperative IL-6 (>7 pg ml−1). PMI occurred in two (8.3%) and eight (12.5%) patients with high and normal concentrations, respectively (P=0.86). Patients with high IL-6 had higher preoperative concentrations of hs-cTnT (11.0 [inter-quartile range 7.0–15.0] vs 8.0 [5.0–11.0] pg ml−1, P=0.01), GDF-15 (1924.5 [1403.8–2797.5] vs 1445.0 pg ml−1 [1006.5–1905.3] pg ml−1, P=0.021) and NT-proBNP (279.5 [128.8–569.0] vs 116.5 [65.1–226.5] pg ml−1, P=0.012). All biomarkers increased after surgery (all P<0.05), yet this increase was similar among patients with high or normal preoperative IL-6 concentrations.
Conclusions
Preoperative inflammation was not associated with PMI or postoperative biomarkers of heart failure after pancreatic surgery. However, patients with high IL-6 concentrations had higher preoperative concentrations of cardiac biomarkers, suggesting the presence of subclinical cardiovascular disease.