非心脏手术与炎症反应有关。围手术期炎症增加是否与随后的发病率和死亡率相关尚不清楚。从开始之日起至 2023 年 5 月对 MEDLINE、EMBASE 和 CENTRAL 进行了系统搜索。如果纵向研究报告了术前测量的生物标志物和/或生物标志物的多变量调整关联，则纳入纵向研究。或非心脏手术患者术后 10 天内出现至少一种预先指定的不良结果。数据是独立提取的并且一式两份。使用 DerSimonian-Laird 随机效应模型汇总风险估计，并以 95% CI 的汇总比值比 (OR) 报告。结果是全因死亡率和主要不良心血管事件。纳入了 52 项研究，总共 121,849 名患者。中位随访时间为 56 [IQR，28-63] 个月，平均年龄为 57 (±3) 岁。术前 C 反应蛋白 (CRP) 水平升高与较高的死亡风险相关（OR 1.57，95% CI 1.29-1.90，I2 = 93%，28 项研究）。与癌症手术人群（OR 1.51，95% CI 1.26-1.81，I2 = 83%）相比，这种关联在非癌症手术人群中更强（OR 2.10，95% CI 1.92-2.31，I2 = 0%，4项研究） ，24 项研究）（亚组差异 p = 0.001）。同样，较高的术后 CRP 水平与全因死亡率相关（OR 1.61，95% CI 1.17-2.20，I2 = 90%，7 项研究）。术前较高的 CRP 水平与主要心血管事件相关（OR 2.11，95% CI 1.51-2.94，I2 = 0%，2 项研究）。其他术前测量的与全因死亡率相关的生物标志物包括纤维蛋白原（OR 1.48，95% CI 1.05-2.09，I2 = 52%，5 项研究）、白细胞介素 6（OR 1.17，95% CI 1.07-1.28，I2 = 27%） ，3 项研究）和肿瘤坏死因子-α（OR 1.37，95% CI 1.16-1.61，I2 = 0%，2 项研究）。围手术期的炎症生物标志物水平与全因死亡率和不良心血管事件相关。接受非心脏手术的患者。版权所有 © 2024 作者。由爱思唯尔公司出版。保留所有权利。

Noncardiac surgery is associated with an inflammatory response. Whether increased inflammation in the perioperative period is associated with subsequent morbidity and mortality is unknown.MEDLINE, EMBASE, and CENTRAL were systematically searched from date of inception until May 2023. Longitudinal studies were included if they reported multivariable adjusted associations of biomarkers measured preoperatively and/or within 10 days after surgery with at least one prespecified adverse outcome in noncardiac surgery patients. Data were extracted independently and in duplicate. Risk estimates were pooled using DerSimonian-Laird random-effects models and reported as summary odds ratios (ORs) with 95% CIs. The outcomes were all-cause mortality and major adverse cardiovascular events.Fifty-two studies with a total of 121,849 patients were included. The median follow-up was 56 [IQR, 28-63] months and the average age was 57 (±3) years. Elevated preoperative C-reactive protein (CRP) levels were associated with a higher risk of mortality (OR 1.57, 95% CI 1.29-1.90, I2 = 93%, 28 studies). This association was stronger in non-cancer surgery populations (OR 2.10, 95% CI 1.92-2.31, I2 = 0%, 4 studies) when compared to cancer surgery populations (OR 1.51, 95% CI 1.26-1.81, I2 = 83%, 24 studies) (p for subgroup difference = 0.001). Similarly, higher postoperative CRP levels were associated with all-cause mortality (OR 1.61, 95% CI 1.17-2.20, I2 = 90%, 7 studies). Higher preoperative CRP levels were associated with major cardiovascular events (OR 2.11, 95% CI 1.51-2.94, I2 = 0%, 2 studies). Other preoperatively measured biomarkers associated with all-cause mortality were fibrinogen (OR 1.48, 95% CI 1.05-2.09, I2 = 52%, 5 studies), interleukin-6 (OR 1.17, 95% CI 1.07-1.28, I2 = 27%, 3 studies), and tumour necrosis factor-alpha (OR 1.37, 95% CI 1.16-1.61, I2 = 0%, 2 studies).Inflammatory biomarker levels in the perioperative period were associated with all-cause mortality and adverse cardiovascular events in patients undergoing noncardiac surgery.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.