TY - JOUR
T1 - Predicting mortality and morbidity after elective cardiac surgery using vasoactive and inflammatory biomarkers with and without the EuroSCORE model
AU - Schoe, Abraham
AU - Schippers, Emile F.
AU - Ebmeyer, Stefan
AU - Struck, Joachim
AU - Klautz, Robert J. M.
AU - de Jonge, Evert
AU - van Dissel, Jaap T.
PY - 2014
Y1 - 2014
N2 - BACKGROUND: In cardiac surgery, preoperative mortality risk assessment tools like the EuroSCORE help to guide physicians in optimizing perioperative care of patients. We investigated the value of preoperative levels of infl ammatory (procalcitonin [PCT]) and vasoactive (C-terminal pro-arginine vasopressin [CT-proAVP], midregional pro-atrial natriuretic peptide [MR-proANP], midregional proadrenomedullin [MR-proADM], and C-terminal pro-endothelin-1 [CT-proET-1]) biomarkers for risk assessment of mortality and morbidity and compared it with the EuroSCORE. METHODS: We performed a prospective observational cohort study in a single-center academic medical hospital and analyzed 746 consecutive patients undergoing elective cardiac surgery. In a directly preoperative blood sample, we assessed PCT, CT-proAVP, MR-proANP, MR-proADM, and CT-proET-1 levels. RESULTS: In single-variable logistic regression models, all biomarkers predicted 30-day mortality. The biomarkers CT-proET-1 (C statistic, 0.785; 95% CI, 0.687-0.883) and MR-proADM (C statistic, 0.780; 95% CI, 0.671-0.889) predicted 30-day mortality. For the EuroSCORE, the C statistic was 0.689 (95% CI, 0.594-0.784). Th ere was a signifi cant improvement in the prediction of 30-day mortality when the EuroSCORE was combined with MR-proADM (C statistic, 0.792; 95% CI, 0.699-0.884) or CT-proET-1 (C statistic, 0.798; 95% CI, 0.715-0.880). The model with EuroSCORE, MR-proADM, and CT-proET1 had the highest C statistic of 0.803 (95% CI, 0.717-0.890) and was signifi cantly better than the EuroSCORE alone. CONCLUSIONS: In elective cardiac surgery, preoperative levels of MR-proADM and CT-proET-1 are predictors of 30-day mortality and could improve the predictive accuracy of the EuroSCORE. Further research should confi rm the place of these new biomarkers in the prediction of mortality and identifi cation of patients at risk.
AB - BACKGROUND: In cardiac surgery, preoperative mortality risk assessment tools like the EuroSCORE help to guide physicians in optimizing perioperative care of patients. We investigated the value of preoperative levels of infl ammatory (procalcitonin [PCT]) and vasoactive (C-terminal pro-arginine vasopressin [CT-proAVP], midregional pro-atrial natriuretic peptide [MR-proANP], midregional proadrenomedullin [MR-proADM], and C-terminal pro-endothelin-1 [CT-proET-1]) biomarkers for risk assessment of mortality and morbidity and compared it with the EuroSCORE. METHODS: We performed a prospective observational cohort study in a single-center academic medical hospital and analyzed 746 consecutive patients undergoing elective cardiac surgery. In a directly preoperative blood sample, we assessed PCT, CT-proAVP, MR-proANP, MR-proADM, and CT-proET-1 levels. RESULTS: In single-variable logistic regression models, all biomarkers predicted 30-day mortality. The biomarkers CT-proET-1 (C statistic, 0.785; 95% CI, 0.687-0.883) and MR-proADM (C statistic, 0.780; 95% CI, 0.671-0.889) predicted 30-day mortality. For the EuroSCORE, the C statistic was 0.689 (95% CI, 0.594-0.784). Th ere was a signifi cant improvement in the prediction of 30-day mortality when the EuroSCORE was combined with MR-proADM (C statistic, 0.792; 95% CI, 0.699-0.884) or CT-proET-1 (C statistic, 0.798; 95% CI, 0.715-0.880). The model with EuroSCORE, MR-proADM, and CT-proET1 had the highest C statistic of 0.803 (95% CI, 0.717-0.890) and was signifi cantly better than the EuroSCORE alone. CONCLUSIONS: In elective cardiac surgery, preoperative levels of MR-proADM and CT-proET-1 are predictors of 30-day mortality and could improve the predictive accuracy of the EuroSCORE. Further research should confi rm the place of these new biomarkers in the prediction of mortality and identifi cation of patients at risk.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84910011556&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/24992322
U2 - https://doi.org/10.1378/chest.13-2615
DO - https://doi.org/10.1378/chest.13-2615
M3 - Article
C2 - 24992322
SN - 0012-3692
VL - 146
SP - 1310
EP - 1318
JO - Chest
JF - Chest
IS - 5
ER -