Abstract
Introduction Predicting intensive care unit length of stay and outcome following cardiac surgery is currently based on clinical parameters. Novel biomarkers could be employed to improve the prediction models. Materials and Methods We performed a qualitative cytokine screening array to identify highly expressed biomarkers in preoperative blood samples of cardiac surgery patients. After identification of one highly expressed biomarker, growth differentiation factor 15 (GDF-15), a quantitative ELISA was undertaken. Preoperative levels of GDF-15 were compared in regard to duration of intensive care stay, cardiopulmonary bypass time, and indicators of organ dysfunction. Results Preoperatively, GDF-15 was highly expressed in addition to several less highly expressed other biomarkers. After qualitative analysis, we could show that preoperatively raised levels of GDF-15 were positively associated with prolonged ICU stay exceeding 48 h (median 713 versus 1041 pg/ml, p = 0.003). It was also associated with prolonged mechanical ventilation and rates of severe sepsis but not with dialysis rates or cardiopulmonary bypass time. In univariate regression, raised GDF-15 levels were predictive of a prolonged ICU stay (OR 1.01, 95% confidence interval 1–1.02, and p = 0.029). On ROC curves, GDF-15 was found to predict prolonged ICU stay (AUC = 0.86, 95% confidence interval 0.71–0.99, and p = 0.003). Conclusion GDF-15 showed potential as predictor of prolonged intensive care stay following cardiac surgery, which might be valuable for risk stratification models.
Highlights
Predicting intensive care unit length of stay and outcome following cardiac surgery is currently based on clinical parameters
Up to 26% of patients will spend more than 3 days in the intensive care unit (ICU) after cardiac surgery, which is in turn associated with organ dysfunction, prolonged mechanical ventilation, and impaired outcomes [3]
Of the 248 cardiac surgery patients for whom samples were stored in the biobank, 129 had to be excluded due to surgery procedures different from coronary artery bypass grafting (CABG) or aortic valve operations (AVR) or limited sample availability
Summary
Predicting intensive care unit length of stay and outcome following cardiac surgery is currently based on clinical parameters. Whilst several biomarkers have been investigated for use as predictors of mortality and morbidity in cardiac surgery patients, no studies have considered their value in predicting length of stay on the ICU [8, 9]. They could be an additional tool to provide information for preoperative optimization and accurate prediction of postoperative outcomes in this group of vulnerable patients. Biomarkers are already widely used in nephrology to predict kidney failure [10]
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