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:10.3390/jcm10091960

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

J Clin Med. 2021 May 2;10(9):1960. doi: 10.3390/jcm10091960.

Authors

Takashi Kato¹, Toshiaki Nakajima^{2

3}, Taira Fukuda⁴, Ikuko Shibasaki¹, Takaaki Hasegawa³, Koji Ogata¹, Hironaga Ogawa¹, Shotaro Hirota¹, Hirotaka Ohashi¹, Shunsuke Saito¹, Yusuke Takei¹, Masahiro Tezuka¹, Masahiro Seki¹, Toshiyuki Kuwata¹, Masashi Sakuma², Shichiro Abe², Shigeru Toyoda², Teruo Inoue², Hirotsugu Fukuda¹

Affiliations

¹ Department of Cardiovascular Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan.
² Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan.
³ Department of Medical KAATSU Training, Dokkyo Medical University, Tochigi 321-0293, Japan.
⁴ Department of Liberal Arts and Human Development, Kanagawa University of Human Services, Kanagawa 238-8522, Japan.

Abstract

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.

Keywords: ET-1; GDF-15; STS risk score; acute kidney injury; cardiopulmonary bypass time; cardiovascular surgery; endothelin-1; growth differentiation factor-15; morbidity; mortality; operative risk.