Clinical Utility of Survivin (BIRC5), Novel Cardiac Biomarker, as a Prognostic Tool Compared to High-Sensitivity C-Reactive Protein, Heart-Type Fatty Acid Binding Protein and Revised Lee Score in Elderly Patients Scheduled for Major Non-Cardiac Surgery: A Prospective Pilot Study

Abstract

SummaryBackgroundRecent studies indicate that survivin (BIRC5) is sensitive to the existence of previous ischemic heart disease, since it is activated in the process of tissue repair and angiogenesis. The aim of this study was to determine the potential of survivin (BIRC5) as a new cardiac biomarker in the preoperative assessment of cardiovascular risk in comparison with clinically accepted cardiac biomarkers and one of the relevant clinical risk scores.MethodsWe included 79 patients, female (41) and male (38), with the mean age of 71.35±6.89. Inclusion criteria: extensive non-cardiac surgery, general anesthesia, age >55 and at least one of the selected cardiovascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking and positive family history). Exclusion criteria: emergency surgical procedures and inability to understand and sign an informed consent. Blood sampling was performed 7 days prior surgery and levels of survivin (BIRC5), hsCRP and H-FABP were measured.ResultsRevised Lee score was assessed based on data found in patients’ history. Levels of survivin (BIRC5) were higher in deceased patients (P<0.05). It showed AUC=0.807 (95% CI, P<0.0005, 0.698–0.917), greater than both H-FABP and revised Lee index, and it increases the mortality prediction when used together with both biomarkers and revised Lee score. The determined cut-off value was 4 pg/mL and 92.86% of deceased patients had an increased level of survivin (BIRC5), (P=0.005).ConclusionsSurvivin (BIRC5) is a potential cardiac biomarker even in elderly patients without tumor, but it cannot be used independently. Further studies with a greater number of patients are needed.

Relationship of High Circulating Cystatin C to Biochemical Markers of Bone Turnover and Bone Mineral Density in Elderly Males with a Chronic Heart Failure

“…There was a significant relative risk of systolic CHF in elderly males associated with elevated CysC above the calculated cut-off of 1250 pg/mL. In agreement with previous studies presented in literature about the influence of CysC on CHF (11, 12), CHF patients in the T1 and T2 age tertiles had higher CysC values compared to HS in the same age tertiles. Additional confirmation of this finding was a significantly increased CysC level in elderly males with CHF NYHAIII compared to HS, while elderly males with CHF NYHAII had no statistically significantly increased CysC values in the same comparison.…”

“…CysC is a marker of renal function (5) and cardiovascular disease risk (11, 12), but its precise role in CHF has not been well established. CysC is associated with both more advanced left ventricular diastolic dysfunction and right ventricular systolic dysfunction; therefore it remains an independent predictor of long-term prognosis in chronic systolic (26).…”

“…Higher levels of CysC were associated with an increased overall/cardiovascular cause of mortality in the population based cohort of ambulatory elderly persons (11). The CysC concentration is additionally an independent risk factor for heart failure in older adults (12). Therefore, serum CysC may be a useful surrogate marker of cardiovascular pathology.…”

Plasma cathepsin S is associated with high-density lipoprotein cholesterol and bilirubin in patients with abdominal aortic aneurysms

“…The often-described background mechanism linking Cys C with atherogenesis is that it is a potent endogenous inhibitor of CTSS (11, 29). In this respect, we expected the association of decreased Cys C concentrations with an increased CTSS.…”

“…Since several theories are based on the fact that different risk factors promote atherosclerosis, the focus of this paper was on markers associated with CTSS in patients with AAA and AOD. Cystatin C (Cys C) is an endogenous inhibitor of cysteine peptidases also known as a marker for atherosclerosis (11). In vitro studies indicate that CTSS may have an impact on lipoproteins metabolism.…”