Journal of Clinical Medicine (May 2021)

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

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

DOI
https://doi.org/10.3390/jcm10091960
Journal volume & issue
Vol. 10, no. 9
p. 1960

Abstract

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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.

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