Abstract 9431: Preoperative Serum Gdf-15, Endothelin-1 Levels, and Intraoperative Factors as Short-Term Operative Risks for Patients Undergoing Cardiovascular Surgery

Abstract

Introduction: The Society of Thoracic Surgeons (STS) risk score is widely used for the risk assessment of cardiac surgery. Serum biomarkers such as growth differentiation factor-15 (GDF-15) and endothelin-1 (ET-1) are also used to evaluate risk. Hypothesis: To investigate the relationships between preoperative serum GDF-15, ET-1 levels, and intraoperative factors and short-term operative risks including acute kidney injury (AKI) for patients undergoing cardiovascular surgery. Methods: Total 145 patients were included in this study (92 males and 53 females, age 68.4 ± 13.2 years). The preoperative STS score was determined, and the serum GDF-15 and ET-1 levels were measured by Enzyme-Linked Immunosorbent Assay. These were related to postoperative risks, including AKI, defined according to the Acute Kidney Injury Network (AKIN) classification criteria. Results: AKI developed in 23% of patients. The GDF-15 and ET-1 levels correlated with the STS score. The STS score and GDF-15 and ET-1 levels all correlated with preoperative eGFR, Alb, Hb, and BNP levels; perioperative data (urine output); ICU stay period; and postoperative admission days. Patients with AKI had longer circulatory pulmonary bypass (CPB) time, and male patients with AKI had higher ET-1 levels than those without AKI. The risk of developing AKI increased with increasing preoperative ET-1 level at baseline (OR for 1 pg/mL increase in ET-1, 2.177; 95% CI, 1.034-4.584; p = 0.041) and CPB time (OR for 1 h increase in CPB time, 4.194; 95% CI, 2.005-8.773; p < 0.001), even adjusted by age, sex, and BMI. In addition, multivariable logistic regression analysis showed that the risk of 30-day mortality plus morbidity increased with increasing preoperative GDF-15 level at baseline, CPB time, and RCC transfusion, even adjusted for age, gender, and BMI. Conclusion: The present study provides evidence that preoperative GDF-15 and ET-1 levels as well as intraoperative factors such as CPB time may be helpful to identify short-term operative risk for patients undergoing cardiovascular surgery.