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Cardiac biomarkers improve prediction performance of the combination of American Society of Anesthesiologists physical status classification and Americal College of Surgeons National Surgical Quality Improvement Program calculator for postoperative mortality in elderly patients: a pilot study

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Abstract

Background

Our previous research has shown American Society of Anaesthesiologists physical status classification (ASA) score and Americal College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator to have the most accuracy in the prediction of postoperative mortality.

Aims

The aim of our research was to define the most reliable combination of cardiac biomarkers with ASA and ACS NSQIP.

Methods

We have included a total of 78 patients. ASA score has been determined in standard fashion, while we used the available interactive calculator for the ACS NSQIP score. Biomarkers BIRC5, H-FABP, and hsCRP have been measured in specialized laboratories.

Results

All of the deceased patients had survivin (BIRC5) > 4.00 pg/ml, higher values of H-FABP and hsCRP and higher estimated levels of ASA and ACS NSQIP (P = 0.0001). ASA and ACS NSQIP alone had AUC of, respectively, 0.669 and 0.813. The combination of ASA and ACS NSQIP had AUC = 0.841. Combination of hsCRP with the two risk scores had AUC = 0.926 (95% CI 0.853–1.000, P < 0.0001). If we add three cardiac biomarkers to this model, we get AUC as high as 0.941 (95% CI 0.876–1.000, P < 0.0001). The correction of statistical models with comorbidities (CIRS-G score) did not change the accuracy of prediction models that we have provided.

Discussion

Addition of ACS NSQIP and biomarkers adds to the accuracy of ASA score, which has already been proved by other authors.

Conclusion

Cardiac biomarker hsCRP can be used as the most reliable cardiac biomarker; however, the “multimarker approach” adds the most to the accuracy of the combination of clinical risk scores.

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Acknowledgements

We would like to thank Miodrag Krstić, Master Engineer of Electrical Engineering and Computer Science, for his assistance in statistical analyses of data.

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Authors and Affiliations

  1. General Surgery Clinic, Center for Anestesiology and Reanimatology, Clinical Center in Niš, Bulevar Dr Zorana Djindjica 48, Niš, 18000, Serbia

    Danica Z. Markovic, Anita Z. Vukovic, Vesna Dinic & Radmilo J. Jankovic

  2. Department for Biochemistry, Medical School, University in Niš, Bulevar Dr Zorana Djindjica 81, Niš, 18000, Serbia

    Tatjana Jevtovic-Stoimenov

  3. Medical School, University in Nis, Bulevar Dr Zorana Djindjica 81, Nis, 18000, Serbia

    Milena Stojanovic

  4. Medical High School ‘Dr. Milenko Hadžić’, Zetska 55, Niš, 18000, Serbia

    Bojana Z. Markovic-Zivkovic

  5. Department for Emergency Medicine, Medical School, University in Niš, Bulevar Dr Zorana Djindjica 81, Niš, 18000, Serbia

    Radmilo J. Jankovic

Authors
  1. Danica Z. Markovic
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  2. Tatjana Jevtovic-Stoimenov
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  3. Milena Stojanovic
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Correspondence to Danica Z. Markovic.

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The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval for this study was provided by the Ethical Committee of Medical School, University in Nis, Nis, Serbia.

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All of the included patients signed the informed consent.

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Markovic, D.Z., Jevtovic-Stoimenov, T., Stojanovic, M. et al. Cardiac biomarkers improve prediction performance of the combination of American Society of Anesthesiologists physical status classification and Americal College of Surgeons National Surgical Quality Improvement Program calculator for postoperative mortality in elderly patients: a pilot study. Aging Clin Exp Res 31, 1207–1217 (2019). https://doi.org/10.1007/s40520-018-1072-0

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  • DOI: https://doi.org/10.1007/s40520-018-1072-0

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