It's all in our skin-Skin autofluorescence-A promising outcome predictor in cardiac surgery: A single centre cohort study.

Britt Hofmann,Christopher Zitterbart,Rolf-Edgar Silber,Sissy Richter,Friederike Fee Bartel,Kristin Anja Gerull,Andreas Wienke,Christian Erbs,Katja Bloch,Anna Fröhlich,Andreas Simm,Pauline Siegel,Martin Ehrhardt,Marcus Riemer,Andrea Ballotta

doi:10.1371/journal.pone.0234847

Abstract

BackgroundThe optimum risk score determining perioperative mortality and morbidity in cardiac surgery remains debated. Advanced glycation end products (AGEs) derived from glycaemic and oxidative stress accumulate to a comparable amount in skin and the cardiovascular system leading to a decline in organ function. We aimed to study the association between AGE accumulation measured as skin autofluorescence (sAF) and the outcome of cardiac surgery patients.MethodsBetween April 2008 and November 2016, data from 758 consecutive patients undergoing coronary artery bypass grafting, aortic valve replacement or a combined procedure were analyzed. Skin autofluorescence was measured using an autofluorescence reader. Beside mortality, for the combined categorical morbidity outcome of each patient failure of the cardiac-, pulmonary-, renal- and cerebral system, as well as reoperation and wound healing disorders were counted. Patients without or with only one of the outcomes were assigned zero points whereas more than one outcome failure resulted in one point. Odds ratios (ORs) were estimated in multivariable logistic regression analysis with other preoperative parameters and the established cardiac surgery risk score systems EuroSCORE II and STS score.ResultsSkin autofluorescence as non-invasive marker of tissue glycation provided the best prognostic value in identifying patients with major morbidity risks after cardiac surgery (OR = 3.13; 95%CI 2.16–4.54). With respect to mortality prediction the STS score (OR = 1.24; 95%CI 1.03–1.5) was superior compared to the EuroSCORE II (OR = 1.17: 95%CI 0.96–1.43), but not superior when compared to sAF (OR = 6.04; 95%CI 2.44–14.95).ConclusionThis finding suggests that skin autofluorescence is a good biomarker candidate to assess the perioperative risk of patients in cardiac surgery. Since the EuroSCORE does not contain a morbidity component, in our view further sAF measurement is an option.

Highlights

There is still a wide debate concerning the performance of commonly used risk prediction models in assessing the risk of patients undergoing cardiac surgery
Advanced glycation end products (AGEs) derived from glycaemic and oxidative stress accumulate to a comparable amount in skin and the cardiovascular system leading to a decline in organ function
We aimed to study the association between AGE accumulation measured as skin autofluorescence and the outcome of cardiac surgery patients

Summary

Introduction

There is still a wide debate concerning the performance of commonly used risk prediction models in assessing the risk of patients undergoing cardiac surgery. Cardiac surgeons are more and more faced with old and geriatric patients and their wish to know the predicted surgical mortality but the expected morbidity rate as well. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is one of the most widely used scores to predict perioperative mortality in cardiac surgery, together with The Society of Thoracic Surgeons (STS) score. Only the STS score offers morbidity risk prediction. The optimum risk score determining perioperative mortality and morbidity in cardiac surgery remains debated. We aimed to study the association between AGE accumulation measured as skin autofluorescence (sAF) and the outcome of cardiac surgery patients

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Methods

Conclusion