Inflammatory Status as a Predictor of Perioperative Risk in Patients Undergoing Non-Cardiac Vascular Surgery.

Abstract

Background: Patients scheduled to undergo vascular surgery represent a significant population at risk of major adverse cardiac events (MACE's) post operation. This is due to a number of inflammatory mechanisms, designed to aid in postsurgical recovery. A number of screening tools have been designed, such as the Eagle risk score or the Goldman and Detsky scores, to aid in identification of at-risk individuals. Recently, inflammatory biomarkers have been suggested as a tool to aid in this assessment. The role of interleukins (ILs), such as IL-1 and IL-6, has particularly been of interest to current research. Our hypothesis aims to test whether there is any benefit to measuring inflammatory biomarkers post operation as a tool to identify individuals at the risk of MACEs.

Methods: We identified 75 eligible patients scheduled to undergo vascular surgery (bypass, endovascular aneurysm repair or open abdomnial aortic aneurysm repair, or endarterectomy) and measured 4 inflammatory biomarkers (IL-1, IL-6, intercellular adhesion molecule-1 (ICAM-1), and C-reactive protein [CRP]) pre and postoperatively on days 1-4 to identify correlations and identify differences in individuals who had a MACE versus those that did not. A MACE was defined by a rise in T troponin of 0.06 or greater or electrocardiogram changes agreed upon by 2 clinicians or a stroke.

Results: Of the 75 patients, 13 were identified to have a MACE. The result showed that both IL-1 and ICAM show a significantly positive correlation between pre and postoperative levels, with ICAM-1 significantly positive on all 4 days and IL-1 significantly positive on days 1, 3, and 4. When comparing the significant difference in change in inflammatory biomarkers between the MACE group and non-MACE group, a significant difference was only noted in the ICAM biomarker. ICAM was significantly different between the 2 groups on day 1 and day 2 (t test value 0.0455 and 0.0492, respectively) but was nonsignificant on days 3 and 4. All other biomarkers showed no significant difference pre and postop.

Conclusions: Overall, it is suggestable that measuring inflammatory biomarkers in vascular surgery patients is a valuable aid to clinicians in potentially identifying at-risk groups and should be used as an adjunct to already existing mechanisms available to the clinician.