Evidence map›Paper›PMID 30686303›Full record

Observational studyBritish journal of anaesthesia2019

Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery.

G L Ackland, T E F Abbott, D Cain, M R Edwards, P Sultan, S N Karmali, A J Fowler, J R Whittle, N J MacDonald, A Reyes and 11 more

2 registry-linked trialsOpen access · bronzeAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in British journal of anaesthesia, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 54 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
54citing papers in PubMed, 3 pooled it
8.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01842568 completednot on this map

Vascular Events In Surgery patIents cOhort evaluatioN - Cardiac Surgery

TypeobservationalSponsorPopulation Health Research InstituteRan2013 to 2025Enrolled15,989ConditionsVascular Death, Myocardial Infarction, Stroke, Cardiac Surgery
NCT07394647 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Transcutaneous Auricular Vagus Nerve Stimulation for Preventing Emergence Agitation and Delirium After Pediatric Tonsillectomy and Adenoidectomy: A Randomized, Double-Blind, Interventional Study

TypeinterventionalSponsorThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityRan2026 to 2026Enrolled120ConditionsEmergence Agitation, Emergence DeliriumArmsActive taVNS Group, Sham stimulation group
3 · Its place in the literature

Who cites it

54 citing papers in PubMed, 3 syntheses or guidelines pooled it, 112 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors at 5 institutions in 1 country.

G L AcklandTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK. Electronic address: g.ackland@qmul.ac.uk.
T E F AbbottTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
D CainUniversity College London NHS Hospitals Trust, London UK.
M R EdwardsUniversity College London NHS Hospitals Trust, London UK.
P SultanUniversity College London NHS Hospitals Trust, London UK.
S N KarmaliTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
A J FowlerTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
J R WhittleUniversity College London NHS Hospitals Trust, London UK.
N J MacDonaldTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
A ReyesUniversity College London NHS Hospitals Trust, London UK.
L Gallego ParedesUniversity College London NHS Hospitals Trust, London UK.
R C M StephensUniversity College London NHS Hospitals Trust, London UK.
A Gutierrez Del ArroyoUniversity College London NHS Hospitals Trust, London UK.
S WoldmanBarts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.
R A ArchboldBarts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.
A WraggBarts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.
E KamTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
T AhmadTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
A W KhanTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
E NiebrzegowskaTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
R M PearseTranslational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
William Harvey Research Institute · GBUniversity College London · GBUniversity College London Hospitals NHS Foundation Trust · GBBarts Health NHS Trust · GBQueen Mary University of London · GB

Funding

British Heart Foundation RG/14/4/30736Department of Health RP_2014-04-022
6 · The paper itself

Abstract

backgroundSystemic inflammation is pivotal in the pathogenesis of cardiovascular disease. As inflammation can directly cause cardiomyocyte injury, we hypothesised that established systemic inflammation, as reflected by elevated preoperative neutrophil-lymphocyte ratio (NLR) >4, predisposes patients to perioperative myocardial injury.

methodsWe prospectively recruited 1652 patients aged ≥45 yr who underwent non-cardiac surgery in two UK centres. Serum high sensitivity troponin T (hsTnT) concentrations were measured on the first three postoperative days. Clinicians and investigators were blinded to the troponin results. The primary outcome was perioperative myocardial injury, defined as hsTnT≥14 ng L

resultsPreoperative NLR>4 was present in 239/1652 (14.5%) patients. Myocardial injury occurred in 405/1652 (24.5%) patients and was more common in patients with preoperative NLR>4 [OR: 2.56 (1.92-3.41); P<0.0001]. Myocardial injury was independently associated with lower absolute preoperative lymphocyte count [OR 1.80 (1.50-2.17); P<0.0001] and higher absolute preoperative monocyte count [OR 1.93 (1.12-3.30); P=0.017]. Monocyte ROS generation correlated with NLR (r=0.47; P=0.03).

conclusionsPreoperative NLR>4 is associated with perioperative myocardial injury, independent of conventional risk factors. Systemic inflammation may contribute to the development of perioperative myocardial injury. CLINICAL

trial registrationNCT01842568.

Indexed as

AgedCohort StudiesFemaleHeart InjuriesHumansIntraoperative ComplicationsLymphocyte CountMaleMiddle AgedMonocytesPostoperative ComplicationsProspective StudiesReactive Oxygen SpeciesRisk FactorsSurgical Procedures, OperativeSystemic Inflammatory Response SyndromeReactive Oxygen SpeciesTroponin Tcardiac riskinflammationleukocyte countsurgerytroponin

Identifiers

PMID30686303
PMCPMC6354048
OpenAlexW2894312767

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.