Postoperatively increased bioactive adrenomedullin is related to adverse outcome after complex aortic surgery

Abstract

Summary: Background: Open and endovascular thoracoabdominal aortic aneurysm repair is related to major complications and increased mortality rates. Up to now, specific biomarkers for adverse outcome are scarce, although routine usage of such biomarkers could enable an earlier and more appropriate treatment of complications during the postoperative course after complex aortic aneurysm repair. Patients and methods: In a prospective single-center study including 33 patients (48.5 % women, mean age 63.0 ± 16.2 years) undergoing elective complex open and endovascular aortic aneurysm repair, bioactive adrenomedullin (bio-ADM) was measured for 72 h perioperatively and an association with clinical endpoints, namely cardiogenic shock, death and the combined endpoint of the two aforementioned parameters was assessed. Furthermore, the association between bio-ADM and baseline characteristics and perioperative details including sepsis biomarkers score were assessed. Results: 51.5 % (n = 17) of patients developed postoperative acute kidney injury, 21.2 % (n = 7) pneumonia and 18.2 % (n = 6) sepsis. Cardiogenic shock was observed in 12.1 % (n = 4) patients. The in-hospital mortality rate was 18.2 % (n = 6), and 24.2 % (n = 8) of patients developed cardiogenic shock and/or died in hospital. A significant correlation of bio-ADM concentrations from all available time points was observed with leukocytes (r = 0.37, P < 0.0001), C-reactive protein (r = 0.56, P < 0.001) and serum creatinine levels (r = 0.52, P < 0.001). Increased bio-ADM at 12 h, 24 h, 48 h and 72 h after admission to ICU was associated with both, in-hospital death and cardiogenic shock, with an area under the curve for the combined endpoint of 0.598, 0.720, 0.880 and 0.967. Bio-ADM concentrations at 48 h and 72 h after admission to ICU were predictive for in-hospital death and cardiogenic shock (both P < 0.01). Conclusions: Bio-ADM may serve as postoperative biomarker for cardiogenic shock and death after complex open and endovascular aortic aneurysm repair, potentially enabling an earlier and by that more adequate treatment of adverse outcome after major surgery.

The NephroCheck bedside system for detecting stage 3 acute kidney injury after open thoracoabdominal aortic repair

“…We also found that severe AKI was the most frequent complication after surgery, and it was significantly associated with other severe complications. For example, postoperatively, we observed clear correlations between AKIs and surgical revisions (mainly re-thoracotomy), bleeding complications, mass transfusions, sepsis, and multi-organ failure, again in accordance with the literature 1 , 21 . Furthermore, respiratory complications were the foremost complication: patients that required dialysis needed longer invasive ventilation times (560 h vs. 10.5 h), were more susceptible to pulmonary infections (76.2% vs. 20.8%), and were prone to hypoxaemia in the setting of severe ARDS (47.6% vs. 4.2%).…”

Postoperative bioactive adrenomedullin is associated with the onset of ARDS and adverse outcomes in patients undergoing open thoracoabdominal aortic surgery

“…Increased bio-ADM levels have been found to offer valuable guidance in risk stratification in hemodynamically impaired patients 21 , 42 . The diagnostic value of bio-ADM in patients undergoing cardiac surgery was recently reported by Hill et al, who observed an association between bio-ADM levels and the need for vasopressors, indicating compromised circulation in this patient population 43 .…”

“…Increased levels of bio-ADM are associated with higher mortality in septic patients 16 – 19 and have been proposed as a sepsis biomarker independent of morbidity 20 . In a previous study by our group, we investigated the role of bio-ADM during the postoperative phase of patients undergoing open or endovascular aortic reconstructions and found a significant association between bio-ADM levels and the development of cardiogenic shock or fatal outcomes 21 .…”