Key result
Higher pre-operative platelet-bound CD40 ligand levels were independently associated with peri-operative cardiac events following hip or knee arthroplasty (median 0.55% vs 0.29%, P=0.02; AUC 0.79).
Why the study?
Does pre-operative platelet-bound CD40 ligand predict peri-operative cardiac events in patients undergoing hip and knee arthroplasty?
Observational (n=62)
Does pre-operative platelet-bound CD40 ligand predict peri-operative cardiac events in patients undergoing hip and knee arthroplasty?
Pre-operative platelet-bound CD40 ligand levels are independently associated with peri-operative cardiac events in patients undergoing major orthopedic surgery, suggesting potential utility for risk stratification.
May support peri-operative risk stratification in arthroplasty; leaves open whether it adds value beyond standard models.
BACKGROUND: Peri-operative cardiac events are common and associated with significant morbidity. A predictive biomarker would assist in pre-operative risk stratification of surgical patients. This study explored the utility of pre-operative measurements of platelet-bound CD40 ligand and other biomarkers for predicting peri-operative cardiac events in total hip or knee arthroplasty. METHODS: Blood samples were collected from 62 patients prior to surgery and tested for the biomarkers platelet CD40 ligand, platelet factor V/Va, platelet P-selectin, high-sensitivity C-reactive protein, B-type natriuretic peptide and soluble CD40 ligand. The Revised Cardiac Risk Index was also calculated. Patients were then followed up prospectively and screened for peri-operative cardiac events by means of ECG, serial troponin I, a cardiologist's review and an interview at 6 weeks post operation. RESULTS: Six of 62 (9.7%) patients had a cardiac event. Patients who experienced a cardiac event had higher pre-operative platelet CD40 ligand levels as measured by flow cytometry [median 0.55% vs. 0.29% (P = 0.02)]. In this sized sample, platelet CD40L was the only biomarker independently associated with cardiac events (P = 0.02), the area under the receiver-operator characteristic curve being 0.79. CONCLUSION: In a study of this number of patients, of the six biomarkers tested, only platelet CD40 ligand was found to have a probable association with peri-operative cardiac events in hip and knee arthroplasty.
No takes yet. Share an insight, caveat, or question.
Ray et al. (2010) conducted an observational in Total hip or knee arthroplasty (n=62). Pre-operative platelet-bound CD40 ligand vs. Lower levels of platelet-bound CD40 ligand was evaluated on Peri-operative cardiac events (AUC 0.79, p=0.02). Higher pre-operative platelet-bound CD40 ligand levels were independently associated with peri-operative cardiac events following hip or knee arthroplasty (median 0.55% vs 0.29%, P=0.02; AUC 0.79).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: