Background: Recent studies indicate that survivin (BIRC5) is sensitive to the existence of previous ischemic heart disease, since it is activated in the process of tissue repair and angiogenesis. The aim of this study was to determine the potential of survivin (BIRC5) as a new cardiac biomarker in the preoperative assessment of cardiovascular risk in comparison with clinically accepted cardiac biomarkers and one of the relevant clinical risk scores.
Methods: We included 79 patients, female (41) and male (38), with the mean age of 71.35±6.89. Inclusion criteria: extensive non-cardiac surgery, general anesthesia, age >55 and at least one of the selected cardiovascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking and positive family history). Exclusion criteria: emergency surgical procedures and inability to understand and sign an informed consent. Blood sampling was performed 7 days prior surgery and levels of survivin (BIRC5), hsCRP and H-FABP were measured.
Results: Revised Lee score was assessed based on data found in patients' history. Levels of survivin (BIRC5) were higher in deceased patients (P<0.05). It showed AUC=0.807 (95% CI, P<0.0005, 0.698-0.917), greater than both H-FABP and revised Lee index, and it increases the mortality prediction when used together with both biomarkers and revised Lee score. The determined cut-off value was 4 pg/mL and 92.86% of deceased patients had an increased level of survivin (BIRC5), (P=0.005).
Conclusions: Survivin (BIRC5) is a potential cardiac biomarker even in elderly patients without tumor, but it cannot be used independently. Further studies with a greater number of patients are needed.
Uvod: Novije studije ukazuju da je survivin (BIRC5) osetljiv na prisustvo prethodnih ishemijskih srčanih oboljenja s obzirom na činjenicu da se aktivira u procesu obnove tkiva i angiogeneze. Cilj ove studije je bio da se odredi potencijal survivina (BIRC5) kao novog srčanog biomarkera u pre-operativnoj proceni kardiovaskularnog rizika u poređenju sa klinički prihvaćenim srčanim biomarkerima i relevantnim kliničkim rizik indeksom.
Metode: Uključeno je 79 pacijenata, žena (41) i muškaraca (38) prosečne starosti 71,35±6,89 godina. Kriterijumi uključivanja u studiju su bili: opsežne ne-kardiohirurške operacije, operacija sprovedena pod opštom anestezijom, više od 55 godina i barem jedan od izabranih kardiovaskularnih faktora rizika (hipertenzija, diabetes mellitus, hiperlipidemija, pušenje i pozitivna porodična istorija). Kriterijumi za isključivanje iz studije su bili: hitna hirurška procedura i nesposobnost pacijenta da razume i potpiše informisani pristanak. Uzorkovanje krvi je obavljeno 7 dana pre operacije i određivani sunivoi survivina (BIRC5), hsCRP-a and H-FABP-a. Revidirani Lee indeks je određivan pomoću prethodno uzetih podataka o pacijentu.
Rezultati: Nivoi survivina (BIRC5) u serumu su bili viši kod preminulih pacijenata (P<0,05). Survivin (BIRC5) je pokazao AUC=0,807 (95% CI, P<0,0005, 0,698–0,917), veći u poređenju sa H-FABP i revidiranim Lee indeksom. Takođe je povećavao predikciju mortaliteta kada se koristio u kombinaciji sa oba biomarkera i revidiranim Lee indeksom. Određena je cut-off vrednost od 4 pg/mL. Ukupno 92,86% preminulih pacijenata je imalo povišene nivoe survivina (BIRC5) (P=0,005) u serumu.
Zaključak: Survivin (BIRC5) je potencijalni srčani biomarker čak i kod starijih pacijenata bez prisustva tumora, međutim ne može se koristiti nezavisno. Potrebne su dalje studije sa većim brojem pacijenata.
Keywords: cardiac morbidity: pre-operative factors; peri-operative risk of MI; sensitivity; specificity; survivin.