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

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.