ORIGINAL ARTICLES Value of electrocardiogram and chest X-ray examinations in preoperative management | E7 / Vnitř Lék. 2024;70(8):E3-E10 / VNITŘNÍ LÉKAŘSTVÍ www.casopisvnitrnilekarstvi.cz was also a significant association between chronic coronary syndrome, atrial fibrillation and the risk of PCCS, although on a lower level of statistical significance (p=0.016 and p=0.036 respectively). All patients with a PCCS due to pneumonia detected on a CXR had a significantly higher CRP level than those without pneumonia (median CRPs: 189 vs. 7 mg/l, p=0.001). All patients with pneumonia had CRP levels above 61 mg/l. These patients were also older than the others (mean 81 vs. 63 years, p=0.007), and all were over 69 years old. Furthermore, we found that ages ≥70 years and CRP levels ≥62 mg/l were statistically significant predictors of a change in preoperative management, due to an abnormal CXR (Table 8). There was a significant association between 90-day postoperative all-cause mortality and preoperative heart rate (HR). When using heart rate of 70-79 bpm as a reference point, there was a significantly elevated risk of 90-day postoperative all-cause mortality in patients with HR above 100 bpm (2.08, p=0.005), relative risk further increasing with the higher heart rates, for the detailed distribution of relative risks in the heart rate spectrum see the Table 9 and the Diagram 1. Additionally, there was significantly increased risk of 90-day postoperative all-cause mortality in patients with abnormal CXR (RR=2.49, p=0.001) compared to patients with normal CXR findings (see Table 10). Tab. 6. Relationship between selected patient characteristics and postponement or canceling of surgery due to chest X-ray findings Parameter Category No Delay N = 2,357 PCCS N = 5 P Age 63 (±15) 81 (±7) 0.007 Hypertension No 1,028 (43.6%) 2 (40.0%) 0.999 Yes 1,329 (56.4%) 3 (60.0%) Chronic coronary syndrome No 1,969 (83.5%) 3 (60.0%) 0.193 Yes 388 (16.5%) 2 (40.0%) Chronic heart failure No 2,294 (97.3%) 5 (100.0%) 0.999 Yes 63 (2.7%) 0 (0.0%) Ischemic or hemorrhagic stroke No 2,152 (91.3%) 5 (100.0%) 0.999 Yes 205 (8.7%) 0 (0.0%) Atrial fibrillation No 2,165 (91.9%) 4 (80.0%) 0.347 Yes 192 (8.1%) 1 (20.0%) Diabetes No 1,820 (77.2%) 4 (80.0%) 0.999 Yes 537 (22.8%) 1 (20.0%) Pulmonary disease No 2,048 (86.9%) 5 (100.0%) 0.999 COPD 133 (5.6%) 0 (0.0%) AB 100 (4.2%) 0 (0.0%) ACOS 14 (0.6%) 0 (0.0%) Other 62 (2.6%) 0 (0.0%) BMI, kg/m2 27.8 (±5.6) 28.4 (±5.4) 0.576 Smoking Non-smoker 1,376 (58.4%) 5 (100.0%) 0.243 Smoker 702 (29.8%) 0 (0.0%) Ex-smoker 279 (11.8%) 0 (0.0%) Potassium, mmol/l 4.24 (±0.48) 3.78 (±0.57) 0.050 CRP, mg/l 7 (3–42) 189 (108–231) 0.001 Systolic blood pressure, mmHg 139 (±21) 136 (±19) 0.911 Diastolic blood pressure, mmHg 80 (±12) 71 (±11) 0.067 Heart rate, beats/min 79 (±16) 71 (±10) 0.196 Values are the mean (±standard deviation), number (%), or median (intraquartile range), as indicat-ed. PCCS – postponement or canceling of surgery; COPD – chronic pulmonary obstructive disease; AB – bronchial asthma; ACOS – asthma-COPD overlap syndrome; BMI – body-mass index; CRP – C-reactive protein Tab. 7. Age and heart rate predict change in preoperative management due to electrocardio-gram Predictor AUC (95% CI) P Cut-off Sensitivity Specificity PPV NPV Overall accuracy Age, y 0.786 (0.696–0.876) 0.048 ≥ 72 100.0% 67.1% 0.5% 100.0% 67.2% HR, bpm 0.995 (0.991–1.000) 0.001 ≥ 125 100.0% 98.8% 12.1% 100.0% 98.8% AUC – area under the receiver operating characteristic curve; CI – confidence interval; NPV – neg-ative predictive value; PPV – positive predictive value; HR – heart rate; bpm – beats per minute Tab. 8. Age and CRP as predictors of change in preoperative management due to chest X-ray Predictor AUC (95% CI) P Cut-off Sensitivity Specificity PPV NPV Overall accuracy Age, y 0.850 (0.744–0.955) 0.007 ≥ 70 100.0% 61.5% 0.5% 100.0% 61.6% CRP, mg/l 0.913 (0.855–0.971) 0.001 ≥ 62 100.0% 80.6% 1.2% 100.0% 80.6% AUC – area under the receiver operating characteristic curve; CI – confidence interval; NPV – neg-ative predictive value; PPV – positive predictive value; CRP – C-reactive protein
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