Agrawal Divya S, Motta Jose C, Ali Jason M
School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK.
Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Trumpington, Cambridge CB2 0AY, UK.
J Clin Med. 2025 Sep 1;14(17):6176. doi: 10.3390/jcm14176176.
: Frailty is increasingly recognised as an important contributor to outcomes following cardiac surgery. There are various measures of frailty described, but many include subjective assessments impacting reliability and reproducibility of measurement. A potential biomarker: advanced glycation end products (AGEs) have been suggested to closely correlate with frailty. This may offer the opportunity to objectively measure frailty and have potential use in preoperative risk assessment. The objective and aim of this narrative review is to assess the association between AGEs and outcomes following surgery, in order to evaluate the use of AGEs for preoperative risk assessment. : This review involved searching five databases including the following: MEDLINE (through Ovid), Embase, Cochrane, ClinicalTrials.gov, and a specified Google Scholar search for studies published between database inception and 20 February 2025. The 1142 identified articles were then subjected to various inclusion and exclusion criteria. This exclusion criteria included all articles that were not in the English language, studies involving patients under 18 years of age, and studies that were incomplete or for whom the data was not yet available. This left 11 articles for which a 'related articles' search was performed on Google Scholar on 6 March 2025, as per the PRISMA-S extension guidelines, to obtain all relevant articles available. In the end, data analysis was conducted on 13 articles with a total of 2402 participants. These were categorised by type of surgery before analysis was performed for each surgical category. The quality of evidence was assessed using ROBINS-I tool and a risk of bias table has been provided. This study was provided no external sources of funding. : Four out of the five studies in cardiac surgery showed a statistically significant association between AGE levels and post-operative complications and outcomes. This association was also seen across thoracic and general surgery. Association was demonstrated with various post-operative complications as well as mortality. These relationships are supported by various pathophysiological mechanisms, including the ability of AGEs to induce oxidative stress, activate inflammatory mediators, and cause endothelial dysfunction. : There is a body of evidence supporting the association between AGEs level and cardiac surgical outcomes. This objective measure of frailty could have significant utility in preoperative risk assessment and offer the opportunity to identify patients who will benefit from undergoing prehabilitation.
衰弱越来越被认为是心脏手术后影响预后的一个重要因素。目前描述了多种衰弱的测量方法，但许多方法包括主观评估，这影响了测量的可靠性和可重复性。一种潜在的生物标志物：晚期糖基化终产物（AGEs）已被认为与衰弱密切相关。这可能为客观测量衰弱提供机会，并在术前风险评估中具有潜在用途。本叙述性综述的目的是评估AGEs与术后预后之间的关联，以评估AGEs在术前风险评估中的应用。
本综述涉及搜索五个数据库，包括：MEDLINE（通过Ovid）、Embase、Cochrane、ClinicalTrials.gov，以及在谷歌学术上进行特定搜索，以查找在数据库建立至2025年2月20日期间发表的研究。然后，对1142篇识别出的文章应用各种纳入和排除标准。排除标准包括所有非英文文章、涉及18岁以下患者的研究，以及不完整或数据不可用的研究。根据PRISMA-S扩展指南，2025年3月6日在谷歌学术上对剩余的11篇文章进行了“相关文章”搜索，以获取所有可用的相关文章。最后，对13篇文章进行了数据分析，共涉及2402名参与者。在对每个手术类别进行分析之前，先按手术类型进行分类。使用ROBINS-I工具评估证据质量，并提供了偏倚风险表。本研究没有外部资金来源。
心脏手术的五项研究中有四项显示AGE水平与术后并发症及预后之间存在统计学上的显著关联。在胸外科和普通外科手术中也观察到了这种关联。AGEs与各种术后并发症以及死亡率之间均存在关联。这些关系得到了多种病理生理机制的支持，包括AGEs诱导氧化应激、激活炎症介质以及导致内皮功能障碍的能力。
有大量证据支持AGEs水平与心脏手术预后之间的关联。这种对衰弱的客观测量在术前风险评估中可能具有重要作用，并有机会识别出将从术前康复中受益的患者。
