Risk Factors for Myocardial Injury in Critical Care Patients after Abdominal Surgery

  Objective  The aim of this study was to investigate the incidence and the possible risk factors for myocardial injury in critical care patients after abdominal surgery.

  Methods  A retrospective study of critical care patients after abdominal surgery from January 2017 to January 2019 in Peking University People's Hospital was carried out. General clinical data and myocardial injury after abdominal surgery were analyzed. The clinical data including medical history, intraoperative conditions (operational time, emergency surgery, intraoperative hemorrhage, and intraoperative hypotension, etc), and postoperative conditions (modified oxygenation index, blood lactic acid, acute kidney injury, vasopressor drugs used within 24h after operation) were observed. According to whether myocardial injury occurred after abdominal surgery, patients were divided into the myocardial injury group and the non-myocardial injury group. Risk factors for myocardial injury after abdominal surgery were analyzed using Logistic regression.

  Results  The incidence of myocardial injury for critical care patients after abdominal surgery was 17.2%(138/803), while the incidence of acute myocardial infarction was only 0.9%(7/803). There were 7 risk factors correlated with myocardial injury after abdominal surgery in critical patients by univariate analysis, including previous chronic kidney disease, operational time, emergency surgery, intraoperative hypotension, vasopressor drugs used within 24 h after operation, APACHE Ⅱ scores, and postoperative acute kidney injury; the independent risk factors for myocardial injury in these patients by Logistic regression analysis included emergency surgery (OR=3.14, 95% CI:1.76-5.60, P < 0.001), administration of vasopressor drugs within 24 h after the operation(OR=2.26, 95% CI:1.23-4.15, P=0.008), high APACHEⅡ scores(OR= 1.05, 95% CI:1.01-1.09, P=0.008), and postoperative acute kidney injury(OR=3.18, 95% CI:1.78-5.69, P < 0.001).

  Conclusions  The incidence of myocardial injury in critical care patients after abdominal surgery is high. Emergency surgery, administration of vasopressor drugs within 24 h after the operation, high APACHEⅡ scores, and postoperative acute kidney injury are the independent risk factors associated with myocardial injury in critical care patients after abdominal surgery.