title: Predicting mortality and morbidity after elective cardiac surgery using vasoactive and inflammatory biomarkers with and without the EuroSCORE model.
abstract: 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 inflammatory (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). There was a significant 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 significantly 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 confirm the place of these new biomarkers in the prediction of mortality and identification of patients at risk.
authors.affiliation: From the Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: a.schoe@lumc.nl.
authors.forename: Abraham
authors.initials: A
authors.lastname: Schoe
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Emile F
authors.initials: EF
authors.lastname: Schippers
authors.affiliation: Thermo Fisher Scientific/BRAHMS GmbH, Hennigsdorf, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ebmeyer
authors.affiliation: Thermo Fisher Scientific/BRAHMS GmbH, Hennigsdorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.affiliation: Department of Thoracic Surgery, Hennigsdorf, Germany; Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Robert J M
authors.initials: RJM
authors.lastname: Klautz
authors.affiliation: From the Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Evert
authors.initials: E
authors.lastname: de Jonge
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Jaap T
authors.initials: JT
authors.lastname: van Dissel
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D006348:Cardiac Surgical Procedures; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers