Assessing the significance of some biomarkers in perioperative period after thoracic aortic reconstruction

Abstract

Aim. This study aims to assess the association between levels of biomarkers and postoperative complications in patients after thoracic and thoracoabdominal aortic reconstruction.Material and methods. This study included 132 patients. The most of them underwent ascending aortic and aortic arch reconstruction (65 and 57, respectively).The concentrations of proadrenomedullin, presepsin, procalcitonin, troponin I and N-terminal brain natriuretic peptide were measured before induction anesthesia, at the end of the surgical operation and in 6 hours after surgery.Results. 69 patients had postoperative complications. Among them, inflammatory (27,3%) and cardiovascular complications (12,1%) prevailed. At the end of the surgical operation, the levels of the biomarkers in patients without postoperative complications and with postoperative complications were for presepsin 326 [206; 451] и 620 [332; 829] p<0,00001, tropononin I 0,77 [0,46; 1,39] and 1,49 [0,59; 3,39], p=0,01, proadrenomedullin 0,894 [0,683; 1,221] and 1,201 [0,944; 1,762], p=0,0002, procalcitonin 0,206 [0,147; 0,452] and 0,563 [0,307; 2,107], p=0,0002, respectively. According to log-linear regression model, the level of prepepsin at the end of the surgical operation >459,5 (odds ratio (OR) 6,84, 95% confidence interval (CI): 3,14-14,87) or proadrenomedullin >0,788 (OR 5,47, 95% CI: 1,52-19,68) are associated with the increased risk of postoperative complications. The level of presepsin >519,5 pg/ml at the end of the surgical operation (OR 4,55, 95% CI: 1,97-10,47) is associated with the increased risk of inflammatory complications. Regarding the prognosis of the risk of prolonged cardiotonic drug infusions, threshold values for troponin were >1,04 at the end of the surgical operation (sensitivity 75%, specificity 71,3%, AUC 0,785), >1,57 in 6 hours after surgery (sensitivity 81,3%, specificity 71,6%, AUC 0,794).Conclusion. High levels of presepsin at the end of the surgical operation may be useful to predict the postoperative complications in patients who underwent the aortic surgery however, the low levels of presepsin do not exclude the development of postoperative complications. The increased level of troponin I at the end of the surgical operation and in 6 hours after surgery can be a predictor of the need for cardiotonic support in the postoperative period.

Keywords

• biomarkers
• presepsin
• proadrenomedullin
• procalcitonin
• troponin i
• n-terminal brain natriuretic peptide
• cardiosurgery
• aortic arch
• ascending aorta