Key result
Elevated preoperative CRP is linked to ~114% higher 30-day mortality and improves EuroSCORE-II risk prediction.
Why the study?
Predicting adverse outcomes following aortic valve surgery remains challenging, motivating investigation into whether preoperative circulating biomarkers can improve established risk stratification tools.
Do preoperative circulating biomarkers improve the prediction of 30-day mortality when added to EuroSCORE-II in patients undergoing surgical aortic valve replacement or repair?
Cohort (n=492)
No
Do preoperative circulating biomarkers improve the prediction of 30-day mortality when added to EuroSCORE-II in patients undergoing surgical aortic valve replacement or repair?
Odds Ratio: 2.14 (95% CI 1.53–3)
p-value: p=<0.001
Combining preoperative circulating biomarkers with established risk models like EuroSCORE-II improves the prediction of adverse outcomes after surgical aortic valve replacement, potentially aiding heart team decision-making.
Background Predicting adverse outcomes following aortic valve surgery remains challenging. This study aimed to investigate the association between preoperative circulating biomarkers and postoperative mortality and morbidity, with the goal of improving established risk stratification tools. Methods Between March 2018 and May 2022, 492 patients underwent surgical aortic valve replacement or repair and were included in a registry. Preoperative blood biomarkers, including hemoglobin, creatinine, high-sensitivity troponin I (hsTrop-I), GOT, GPT, INR, CRP, NT-proBNP and WBC, were sampled at baseline. Logistic regression analysis adjusted for EuroSCORE-II tested associations between biomarker levels and VARC-III adjudicated endpoints. Model fit was assessed using Akaike's Information Criterion, and likelihood ratio tests compared different prediction models. Results Preoperative hemoglobin (OR 0.70; 95% CI: 0.57, 0.87; p < 0.001), creatinine (OR 4.09; 95% CI: 1.63, 10.26; p = 0.003), high-sensitivity troponin I (OR 1.48; 95% CI: 1.11, 1.95; p = 0.007), GOT (OR 2.49; 95% CI: 1.06, 5.86; p = 0.036), INR (OR 4.74; 95% CI: 1.32, 17.05; p = 0.017), CRP (OR 2.14; 95% CI: 1.53, 3.00; p < 0.001), NT-proBNP (OR 2.06; 95% CI: 1.41, 3.00; p < 0.001), and WBC (OR 5.82; 95% CI: 1.88, 17.97; p = 0.002) were independently associated with 30-day mortality after adjustment for EuroSCORE-II. Models combining biomarkers with EuroSCORE-II outperformed those predicting mortality by EuroSCORE-II or biomarkers alone, as indicated by the lowest Akaike's Information Criterion and likelihood ratio tests. Conclusions Combining established risk stratification models with preoperative biomarkers was associated with improved predictive performance for adverse outcomes after aortic valve surgery and may support heart team decision-making when choosing between surgical and transcatheter aortic valve replacement.
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Demal et al. (2026) conducted a cohort in Severe aortic valve disease (n=492). Preoperative circulating biomarkers (e.g., CRP, WBC, NT-proBNP) vs. Lower/reference biomarker levels was evaluated on 30-day mortality (associated with preoperative CRP) (OR 2.14, 95% CI 1.53, 3.00, p=<0.001). Elevated preoperative circulating biomarkers, including CRP (OR 2.14) and WBC (OR 5.82), were independently associated with 30-day mortality and improved risk prediction when added to EuroSCORE-II.
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