O valor pré-operatório dos níveis plasmáticos do receptor solúveldo fator de necrose tumoral tipo I (rs-FNT I) como preditor decomplicações após revascularização do miocárdio e operaçõesvalvares

Abstract

Objective: The objective of this study was to estimate the sTNF-RI preoperative measure in the identification of patients with good outcome and post-operative cardiac surgery mortality rate. Methods: We assessed prospectively sixty-two patients (47 men- 75.8%) submitted electively to myocardial revascularization with extracorporeal circulation (n=43) or isolated heart valve surgery (n=19). The basal sTNF-RI levels (picograms/milliliters) were determined by the Sandwich-Type ELISA method, at the time of anesthetic induction. Clinical and surgical characteristics and sTNF-RI levels were compared among patients whohad presented good outcome (group I, n=46) or bad outcome (group II, n=16), defined by length of stay in the ICU for over 72 hours or death. Results: No difference was found between the verified mortality (6.4%) and the mortality predicted by EuroSCORE (3.0%), p=0.48. The sTNF-RI levels (pg/ml) were higher in group II (1322 [694-1635]) as comparedto group I (748 [532-1041]) p=0.009 (levels > 954, 69% sensitivity and 70% specificity for favorable development, 44% positive predicted value and 85% negative). The sTNF-RI levels were higher in patients who died (1556 [1117-1995]) than in those who survived (759 [555-1141]) p=0.029, (levels > 1230, 79% sensitivity , 75% specificity , 20% positive predicted value and 98% negative). In the multivariate logistic regression model, sTNF-RI (OR=1.002, IC95% 1.000-1.005, p=0.014) and age (OR=1.083, IC95% 1.010-1.161, p=0.025) were independently related to the risk of unfavorable evolution. STNF-RI remained as an independent predictive agent for death (OR = 1.002, IC95% 1.000-1.005, p=0.031).Conclusions: Basal levels of sTNF-RI yield prognostic information in patients who undergo heart surgery.