Longitudinal Analysis of Heparin-Binding Protein (HBP) and Serum Amyloid a Protein (SAA) Versus Interleukin 6 (IL-6), C-Reactive Protein (CRP), and Procalcitonin (PCT) During Both the Acute Postoperative Period and Recovery at Three Months From Non-emergent Cardiac Surgery

Q: What are the key findings of this study?

Serum amyloid A and heparin-binding protein exhibited prolonged elevations for up to 3 months following elective cardiac surgery, diverging from the rapid normalization of classical inflammatory markers.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Elective cardiac surgery (n=99). Intervention: Elective cardiac surgery vs. Preoperative baseline. Primary outcome: Serum SAA levels at 24 hours post-surgery (p=<0.0001).

Q: What does this research mean for the field?

Serum amyloid A (SAA) and heparin-binding protein (HBP) exhibit prolonged elevation following elective cardiac surgery compared to traditional markers, with SAA remaining significantly elevated at three months. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the longitudinal trajectories of novel inflammatory biomarkers, heparin-binding protein and serum amyloid A, compared with traditional markers during acute recovery and at three months following elective cardiac surgery.

Krzysztof Laudański; Ahmed Sayed Ahmed; Mohamed A. Mahmoud; Hossam Gad; Benjamin R.E. Harris; Ryan Smith; Dandan Zhu; Abdelhamed Elgazar; Anil Vasishta; Gajic Ognjen; Daniel A. Diedrich; Juan Crestanello

doi:10.1177/11795468261462607

July 1, 2026Clinical Medicine Insights CardiologyOpen Access

Longitudinal Analysis of Heparin-Binding Protein (HBP) and Serum Amyloid a Protein (SAA) Versus Interleukin 6 (IL-6), C-Reactive Protein (CRP), and Procalcitonin (PCT) During Both the Acute Postoperative Period and Recovery at Three Months From Non-emergent Cardiac Surgery

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Key result

Cardiac surgery triggers prolonged SAA and HBP elevations persisting up to 3 months postoperatively.

P<0.0001
n=99

Figures

Why the study?

Variability in novel inflammatory markers such as HBP and SAA after surgery could indicate ongoing perioperative inflammation.

Key Points

To evaluate the longitudinal trajectories of novel inflammatory biomarkers, heparin-binding protein and serum amyloid A, compared with traditional markers during acute recovery and at three months following elective cardiac surgery.
Prospective pilot cohort study of N=99 patients undergoing elective, non-emergent cardiac surgery.
Serial blood samples were collected at baseline, 24 hours, 7 days, and 3 months postoperatively to quantify HBP, SAA, PCT, CRP, and IL-6 using a point-of-care device.
Serum SAA increased markedly at 24 hours (Me [IQR] SAA baseline = 81.1 [87] vs SAA 24hr = 232.65 [88.02]; U[72]=2343, p<0.0001), remained elevated at 7 days (Me 7d = 252.6 [88.56]; U[57]=1484, p<0.0001), and remained higher than baseline at 3 months (Me 3m = 118.44 [101.52]; U[38]=448, p=0.0008).
HBP demonstrated a delayed rise peaking at 7 days (HBP baseline = 45 [26;89] vs HBP 7d = 121 [69.75;224.5]; U[56]=805, p<0.0001) before returning to near baseline levels at 3 months (Me 3m = 32.5 [15.75;98.5]).
Traditional markers PCT, CRP, and IL-6 rose rapidly at 24 hours post-surgery and plateaued by day 7, while cluster analysis at 24 hours revealed five distinct inflammatory phenotypes linked to age and peripheral artery disease.

Study Design

Type

Cohort (n=99)

Multicenter

No

Structured PICO

P

Population

99 adult patients undergoing elective cardiac surgery were followed for 3 months to evaluate the longitudinal dynamics of novel and traditional inflammatory markers.

E

Exposure

Elective cardiac surgery (observational biomarker tracking)

O

Outcome

Longitudinal variability of inflammatory markers (HBP, SAA, IL-6, CRP, PCT) at baseline, 24 hours, 7 days, and 3 months post-surgerysurrogate

Main Result

Absolute Event Rate: 232.65% vs 81.1%

p-value: p=<0.0001

Novel inflammatory markers SAA and HBP exhibit distinct, prolonged perioperative trajectories compared to classical markers like IL-6 and CRP, suggesting that inflammation and tissue repair processes persist up to 3 months after cardiac surgery.

Limitations

Did not include detailed data on the perioperative administration of heparin and protamine
Underpowered to detect clinically significant associations with outcomes due to a lower incidence of perioperative complications
Did not analyze genetic variants of SAA
Analytes' large dynamic range occasionally exceeded the measurement capabilities of the point-of-care platform, requiring manual dilution
Small sample size based on convenience sampling with no power analysis
Limited number of matched samples at 3 months for HBP analysis
Low overall mortality prevented assessing associations between inflammatory biomarkers and mortality
Observational design did not collect data on other perioperative inflammatory complications (e.g., pericarditis) or vascular remodeling
Not powered to explore clinical outcomes

Implication

Prolonged SAA and HBP elevations may signal persistent inflammation missed by standard markers; hypothesis-generating for post-cardiac surgery monitoring and outcomes.

Abstract

Variability in novel inflammatory markers (HBP and SAA) post-surgery could indicate ongoing perioperative inflammation. This pilot cohort study collected blood from 99 patients undergoing elective cardiac surgery at baseline, 24 hours, 7 days, and 3 months post-surgery. Inflammatory markers (HBP, SAA, PCT, CRP, IL-6) were measured with a point-of-care device. Demographic and clinical data were extracted from health records. Serum SAA increased significantly in the acute postoperative phase (M e [IQR];SAA baseline =81.1[87] vs SAA 24hr= 232.65[88.02];U[72]=2343,p<0.0001), remained elevated at 7 days (Me 7d =252.6[88.56];U[57]=1484,p<0.0001) and were still more pronounced than baseline at t 3m (Me 3m =118.44[101.52];U[38]=448,p=0.0008). HBP showed a significant rise at seven days (HBP baseline =45[26;89] vs HBP 7d =121[69.75;224.5]; U[56]=805,p<0.0001) then returned to near baseline by t 3m (Me 3m =32.5[15.75;98.5]). Traditional inflammatory markers PCT, CRP, and IL-6 demonstrated a rapid increase at t 24h and plateaued at t 7d . None of the biomarkers showed variability at baseline or postoperatively with preoperative status or postoperative complications. Cluster analysis of the inflammatory markers at 24 hours (t 24h ) identified distinct subgroups. Cluster #1-patients with a modest increase in all markers; Cluster#2 characterized with a robust increase in IL-6; Cluster #3 showed increase in CRP and decline in HBP; Cluster #4 showed a modest increase in IL-6 and decline in HBP; Cluster #5 represented a decline in both CRP and SAA. Patients in these clusters differ with respect to age, pre-existing peripheral artery disease, and borderline differences in perioperative acetaminophen use. SAA and HBP remain elevated longer than IL-6, CRP, and PCT after surgery, suggesting that inflammation may persist beyond 3 months.

Discussion

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Cite This Study

Laudański et al. (2026) conducted a cohort in Elective cardiac surgery (n=99). Elective cardiac surgery vs. Preoperative baseline was evaluated on Serum SAA levels at 24 hours post-surgery (p=<0.0001). Serum amyloid A and heparin-binding protein exhibited prolonged elevations for up to 3 months following elective cardiac surgery, diverging from the rapid normalization of classical inflammatory markers.

synapsesocial.com/papers/6a534ff4985393734a594ce0 https://doi.org/10.1177/11795468261462607

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Longitudinal Analysis of Heparin-Binding Protein (HBP) and Serum Amyloid a Protein (SAA) Versus Interleukin 6 (IL-6), C-Reactive Protein (CRP), and Procalcitonin (PCT) During Both the Acute Postoperative Period and Recovery at Three Months From Non-emergent Cardiac Surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Longitudinal Analysis of Heparin-Binding Protein (HBP) and Serum Amyloid a Protein (SAA) Versus Interleukin 6 (IL-6), C-Reactive Protein (CRP), and Procalcitonin (PCT) During Both the Acute Postoperative Period and Recovery at Three Months From Non-emergent Cardiac Surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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