Dogan Leyla, Abugameh Ahmad, Kolashov Alish, Moza Ajay, Goetzenich Andreas, Stoppe Christian, Shoaib Mohammed, Bergmann Deborah, Spillner Jan, Khattab Mohammad Amen, Zayat Rashad
Faculty of Medicine, Department of Cardiac Surgery, University Hospital Aachen, RWTH Aachen University, 52074 Aachen, Germany.
Department of Cardiovascular Surgery, Klinikum Dortmund gGmbH, 44137 Dortmund, Germany.
J Clin Med. 2025 May 21;14(10):3613. doi: 10.3390/jcm14103613.
: In the context of acute heart failure, proenkephalin A (penKid) has emerged as a prognostic marker for acute kidney injury (AKI), whereas bioactive adrenomedullin (bio-ADM) has been identified as a significant biomarker linked to shock and organ dysfunction. This raises the question of whether they can serve as predictors of postoperative complications in patients receiving left ventricular assist devices (LVADs). : This observational study prospectively enrolled patients who had received LVAD implantation. Routine laboratory values as well as plasma levels of penKid and bio-ADM were assessed at four time intervals, spanning from preinduction of anesthesia to 48 h post surgery. Clinical data, the HeartMate 3-risk-score (HM3RS), HeartMateII-risk-score (HMRS), Michigan-right-heart-failure risk score (MRHFS), Euromacs-RHFS (EURORHFS), and kidney failure risk score (KFR) were calculated. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were performed. We entered the biomarkers with the established risk scores into the models. : In 20 patients who had undergone LVAD implantation, preoperative penKid level was a predictor of postoperative AKI (OR: 1.05, 95%-CI: 1.0-1.09; = 0.049) and 30-day mortality (OR: 1.01, 95%-CI: 1.0-1.02; = 0.033). Bio-ADM was the only predictor of postoperative right heart failure (RHF) (OR: 1.11, 95%-CI: 1.01-1.23; = 0.034) and rehospitalization (OR: 1.06, 95%-CI: 1.0-1.13; = 0.047). In the ROC analysis, bio-ADM, as a predictor of post-LVAD RHF, had an area under the curve (AUC) of 0.88. When bio-ADM was added to the accepted clinical scores for post-LVAD RHF prediction (CRITT-score, MRHFS, and EURORHFS), the AUC reached 0.98. The AUC for preoperative penKid, as a predictor of postoperative AKI, was 0.95, and after adding its predictive value to the KFR score, the AUC reached 0.97. : In the present study, the biomarkers penKid and bio-ADM predicted clinically significant patient outcomes after LVAD implantation such as AKI, RHF, and 30-day mortality. Adding biomarkers to well-established risk scores improved the AUC for prediction of postoperative complications.
在急性心力衰竭的背景下，前脑啡肽原A（penKid）已成为急性肾损伤（AKI）的预后标志物，而生物活性肾上腺髓质素（bio-ADM）已被确定为与休克和器官功能障碍相关的重要生物标志物。这就提出了一个问题，即它们是否可以作为接受左心室辅助装置（LVAD）患者术后并发症的预测指标。 ：这项观察性研究前瞻性纳入了接受LVAD植入的患者。在从麻醉诱导前到术后48小时的四个时间间隔内评估常规实验室值以及penKid和bio-ADM的血浆水平。计算临床数据、HeartMate 3风险评分（HM3RS）、HeartMateII风险评分（HMRS）、密歇根右心衰竭风险评分（MRHFS）、Euromacs-RHFS（EURORHFS）和肾衰竭风险评分（KFR）。进行多变量逻辑回归和受试者工作特征（ROC）分析。我们将生物标志物与既定风险评分纳入模型。 ：在20例接受LVAD植入的患者中，术前penKid水平是术后AKI的预测指标（OR：1.05，95%置信区间：1.0 - 1.09；P = 0.049）和30天死亡率的预测指标（OR：1.01，95%置信区间：1.0 - 1.02；P = 0.033）。Bio-ADM是术后右心衰竭（RHF）的唯一预测指标（OR：1.11，95%置信区间：1.01 - 1.23；P = 0.034）和再住院的唯一预测指标（OR：1.06，95%置信区间：1.0 - 1.13；P = 0.047）。在ROC分析中，作为LVAD术后RHF预测指标的bio-ADM的曲线下面积（AUC）为0.88。当将bio-ADM添加到用于LVAD术后RHF预测的公认临床评分（CRITT评分、MRHFS和EURORHFS）中时，AUC达到0.98。术前penKid作为术后AKI预测指标的AUC为0.95，将其预测价值添加到KFR评分后，AUC达到0.97。 ：在本研究中，生物标志物penKid和bio-ADM预测了LVAD植入术后具有临床意义的患者结局，如AKI、RHF和30天死亡率。将生物标志物添加到既定的风险评分中可提高术后并发症预测的AUC。
