Preoperative Serum GDF-15, Endothelin-1 Levels, and Intraoperative Factors as Short-Term Operative Risks for Patients Undergoing Cardiovascular Surgery.

Takashi Kato,Masashi Sakuma,Shigeru Toyoda,Yusuke Takei,Koji Ogata,Ikuko Shibasaki,Hironaga Ogawa,Shotaro Hirota,Masahiro Tezuka,Hirotaka Ohashi,Toshiyuki Kuwata,Shunsuke Saito,Toshiaki Nakajima,Shichiro Abe,Hirotsugu Fukuda,Taira Fukuda,Takaaki Hasegawa,Teruo Inoue,Masahiro Seki

doi:10.3390/jcm10091960

Abstract

Objectives: 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. We investigated 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: In 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 ELISA. 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. In multivariable logistic regression analysis, the preoperative ET-1 level and CPB time were the independent determinants of AKI, even adjusted by age, sex, and BMI. The preoperative GDF-15 level, CPB time, and RCC transfusion were independent determinants of 30-day mortality plus morbidity. Conclusion: Preoperative GDF-15 and ET-1 levels as well as intraoperative factors such as CPB time may be helpful to identify short-term operative risks for patients undergoing cardiovascular surgery.

Highlights

Cardiovascular surgery can be considered even for the elderly and high-risk patients thanks to technological advances, but postoperative complications and mortality remain serious problems
The Society of Thoracic Surgeons (STS) score and growth differentiation factor-15 (GDF-15) and ET-1 levels correlated with eGFR, BNP, Alb, and Hb. (2) The preoperative GDF-15 and ET-1 levels and the STS score correlated with the intraoperative data and postoperative outcomes (ICU stay period and postoperative admission days)
acute kidney injury (AKI). (4) In multivariable logistic regression analysis, the preoperative ET-1 level as well as circulatory pulmonary bypass (CPB) time was an independent determinant of AKI. (5) The preoperative GDF-15 level as well as RCC transfusion and CPB time was an independent determinant of 30-day mortality plus morbidity

Summary

Introduction

Cardiovascular surgery can be considered even for the elderly and high-risk patients thanks to technological advances, but postoperative complications and mortality remain serious problems. Scoring systems such as the Society of Thoracic Surgeons (STS) score are widely used to assess operative risks, including acute kidney injury (AKI) and perioperative outcomes [1,2]. These risk scores are based on a collected database and can be used to predict the risk of death from surgery by entering patient demographics and clinical variables into an easy-to-use online calculator. The STS score is not sufficient in terms of predicting mild to moderate postoperative AKI that does not lead to the introduction of dialysis

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