Prognostic scale for early detection of various postoperative complications after thoracic aortic surgery: post-hoc analysis of biomarkers

Dymova OV, Akselrod BA, Gubko AV, et al. . Prognostic scale for early detection of various postoperative complications after thoracic aortic surgery: post-hoc analysis of biomarkers. Pirogov Russian Journal of Surgery. 2024;(10):38‑48. (In Russ.)
https://doi.org/10.17116/hirurgia202410138

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To create the prognostic scale based on some biomarkers after thoracic and thoracoabdominal aortic repair.

MATERIAL AND METHODS

We analyzed 114 patients with aortic aneurysm/dissection. The following biomarkers were studied: proadrenomedullin, NT-proBNP, procalcitonin, interleukins 6, 8, 10, tumor necrosis factor, presepsin, highly sensitive troponin I. Stages of the study: before induction of anesthesia, at the end of surgery and 6 hours later.

RESULTS

The most informative predictors of postoperative complications were identified using comparative and ROC analyses: baseline presepsin≥204 pg/ml and interleukin 6 ≥4.3 pg/ml. The scale based on assessment of presepsin and troponin I at the end of surgery and preoperative risk allows analysis of the risk of complicated postoperative period. If all three predictors are present, the risk of complicated postoperative period increases by 1.96 times. The equation based on serum presepsin, interleukin-8 and interleukin-6/interleukin-10 ratio in 6 hours after surgery is characterized by acceptable characteristics (AUC 0.785, 95% CI 0.700—0.870).

CONCLUSION

An algorithm based on risk stratification consisting of 3 prognostic scales at various stages of perioperative period determines the probability of postoperative complications with sensitivity 67.2% and specificity 94.6%. The total share of correct predictions in this sample was 80.7±3.7%.

Keywords:

biomarkers

presepsin

interleukin

troponin I

cardiac surgery

cardiac anesthesiology

prognostic scale

prognosis

Authors:

Dymova O.V.

Petrovsky Russian Scientific Center of Surgery

ORCID: 0000-0003-2008-6350

Akselrod B.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-4434-3123

Gubko A.V.

Petrovsky Russian Scientific Center of Surgery

ORCID: 0000-0003-1477-2207

Guskov D.A.

Petrovsky Russian Scientific Center of Surgery

ORCID: 0000-0001-6974-8402

Charchyan E.R.

Petrovsky National Research Centre of Surgery

SPIN RSCI: 4641-0523
Scopus AuthorID: 14044681400
ORCID: 0000-0002-0488-2560

Eremenko A.A.

Petrovsky National Research Center of Surgery

ORCID: 0000-0001-5809-8563

Goncharova A.V.

Petrovsky National Research Center of Surgery

ORCID: 0000-0003-1414-8500

Gladysheva V.G.

Petrovsky National Research Center of Surgery

ORCID: 0000-0002-3703-0911

Received:

21.06.2024

Accepted:

10.07.2024

Close metadata

References:

Gel’fand BR, Yarosheckij AI, Procenko DN, Romanovskij YuYa. Integral’nye sistemy ocenki tyazhesti sostoyaniya bol’nyh pri politravme. Vestnik intensivnoj terapii. 2004;1:1-10. (In Russ.).
Potanina OK, Dorfman AG, Ogurcova EV, Shvyryov SL, Zarubina TV. Sravnenie effektivnosti prognosticheskih shkal ocenki tyazhesti sostoyaniya reanimacionnyh bol’nyh hirurgicheskogo profilya. Vrach i informacionnye tekhnologii. 2011;6:50-61. (In Russ.).
Starostin DO, Shkerdina MI, Kuzovlev AN, Grechko AV. Molecular biomarkers in prediction of neurological outcomes after sudden cardiac arrest. Russian Journal of Anesthesiology and Reanimatology. 2023;(6):99-107. (In Russ.). https://doi.org/10.17116/anaesthesiology202306199
Turgunov YeM, Ogizbayeva AV, Mugazov MM, Asamidanova SG. Biomarkers of intestinal wall damage in multiple organ dysfunction syndrome. Russian Journal of Anesthesiology and Reanimatology. 2024;(2):114-120. (In Russ.). https://doi.org/10.17116/anaesthesiology2024021114
Kamenshchikov NO, Podoksenov YuK, D’yakova ML, Bojko AM, Kozlov BN. Ostroe povrezhdenie pochek v kardiohirurgii: prediktivnaya diagnostika v predoperacionnom periode. Patologiya krovoobrashcheniya i kardiohirurgiya. 2021;25(1):40-51. (In Russ.). https://doi.org/10.21688/1681-3472-2021-1-40-51
Malov AA, Muhoedova TV. Prognoz letal’nyh iskhodov pri dializ-zavisimom ostrompochechnom povrezhdenii posle kardiohirurgicheskih vmeshatel’stv. Patologiya krovoobrashcheniya i kardiohirurgiya. 2012;2:65-69. (In Russ.).
Malov AA, Muhoedova TV. Vybor modal’nosti zamestitel’noj pochechnoj terapii posle kardiohirurgicheskih vmeshatel’stv. Journal of Siberian Medical Sciences. 2012;6:41. (In Russ.).
Shikhverdiev NN, Ushakov DI, Peleshok A, Krivopalov VA, Sizenko VV. New approaches to risk stratification in elderly patients with heart surgery. Clinical and Experimental Surgery. 2019;7(1):23-27. (In Russ.). https://doi.org/10.24411/2308-1198-2019-11003
Govorushkina VP, Kolesnichenko AV, Shirshova EA, Efremov SM. Prediction of the acute heart failure after cardiac valve surgery. Patologiya krovoobrashcheniya i kardiohirurgiya. 2022;26(3):64-72. (In Russ.). https://doi.org/10.21688/1681-3472-2022-3-64-72
Lomivorotov VV, Efremov SM, Boboshko VA, Vedernikov PE, Nikolaev DA. Skrining nutricionnogo statusa v kardiohirurgii. Obshchaya reanimatologiya. 2013;9(1):43. (In Russ.).
Gayfulin RA, Ivanov SV, Gayfulina EN. Preoperative risk stratification in elderly patients in a cardiac surgery clinic. Cardiovascular Therapy and Prevention. 2020;19(2):97-103. (In Russ.). https://doi.org/10.15829/1728-8800-2019-2272
Petrishchev YuI, Levit AL. Predictors of Progression of Multiple Organ Failure After Cardiac Surgery. Anesthesiology and Resuscitation. 2022;3:68-76. (In Russ.). https://doi.org/10.17116/anaesthesiology202203168
Khutornaya MV, Sinitskaya AV, Sinitsky MYu, Asanov MA, Ponasenko AV, Grigoryev EV. Soluble triggering receptor (strem-1) in pathogenesis of multiple organ failure after cardiac surgery. Russian Journal of Anesthesiology and Reanimatology. 2023;1:26-32. (In Russ.). https://doi.org/10.17116/anaesthesiology202301126
Akselrod BA, Dymova OV, Gubko AV, Krasnoshchekova AP, Guskov DA, Goncharova AV, Gladysheva VG, Gubko KV, Kulinchenko OS. Determination of the significance of a number of biomarkers in the perioperative period during reconstructive interventions on the thoracic aorta. Russian Journal of Cardiology. 2023;28(S2):55-65. (In Russ.). https://doi.org/10.15829/1560-4071-2023-5314
Handke J, Scholz AS, Dehne S, Krisam J, Gillmann HJ, Janssen H, Arens C, Espeter F, Uhle F, Motsch J, Weigand MA, Larmann J. Presepsin for pre-operative prediction of major adverse cardiovascular events in coronary heart disease patients undergoing noncardiac surgery: Post hoc analysis of the Leukocytes and Cardiovascular Peri-operative Events-2 (LeukoCAPE-2) Study. European Journal of Anaesthesiology. 2020;37(10):908-919.
Janssen H, Felgner L, Kummer L, Gillmann HJ, Schrimpf C, Rustum S, Lichtinghagen R, Sahlmann B, Weigand MA, Teebken OE, Theilmeier G, Larmann J. Sequential Surgical Procedures in Vascular Surgery Patients Are Associated With Perioperative Adverse Cardiac Events. Frontiers in Cardiovascular Medicine. 2020;7:13. https://doi.org/10.3389/fcvm.2020.00013
Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schuttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Medicine. 1998;24:680-684. https://doi.org/10.1007/s001340050644
Serpa Neto A, Campos PP, Hemmes SN, Bos LD, Bluth T, Ferner M, Güldner A, Hollmann MW, India I, Kiss T, Laufenberg-Feldmann R, Sprung J, Sulemanji D, Unzueta C, Melo MF, Weingarten TN, Boer AM, Pelosi P, Gama de Abreu M, Schultz MJ; PROVE Network Investigators. Kinetics of plasma biomarkers of inflammation and lung injury in surgical patients with or without postoperative pulmonary complications. European Journal of Anaesthesiology. 2017;34(4):229-238. https://doi.org/10.1097/EJA.0000000000000614
Sponholz C, Sakr Y, Reinhart K, Brunkhorst F. Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Critical Care. 2006;10(5):R145. https://doi.org/10.1186/cc5067

Bekki Y, Von Ahrens D, Takahashi H, Schwartz M, Gunasekaran G. Recurrent Intrahepatic Cholangiocarcinoma — Review. Frontiers in Oncology. 2021;11:776863. https://doi.org/10.3389/fonc.2021.776863

Ge Y, Jeong S, Luo GJ, Ren YB, Zhang BH, Zhang YJ, Shen F, Cheng QB, Sui CJ, Wang HY, Xia Q, Chen L. Transarterial chemoembolization versus percutaneous microwave coagulation therapy for recurrent unresectable intrahepatic cholangiocarcinoma: Development of a prognostic nomogram. Hepatobiliary & Pancreatic Diseases International. 2020;19(2):138-146. https://doi.org/10.1016/j.hbpd.2020.02.005

Edeline J, Lamarca A, McNamara MG, Jacobs T, Hubner RA, Palmer D, Groot Koerkamp B, Johnson P, Guiu B, Valle JW. Locoregional therapies in patients with intrahepatic cholangiocarcinoma: A systematic review and pooled analysis. Cancer Treatment Reviews. 2021;99:102258. https://doi.org/10.1016/j.ctrv.2021.102258