Serum creatinine as a perioperative biomarker: A challenge for perioperative management and an opportunity for the Cardiothoracic Surgery Trials Network

摘要

Despite recent advances, coronary artery bypass grafting (CABG) is still associated with adverse outcomes in patients with renal dysfunction both in the short term and in the long term, even when it is subclinical. Serum biomarkers, such as serum creatinine, enhance the identification of high-risk patients and thus may further facilitate targeting of interventions to optimize outcome after CABG. In fact, elevated serum creatinine has already been integrated into standard cardiac surgical risk calculators, such as the Society of Thoracic Surgeons PROM score and the EuroSCORE.Recent evidence, however, has demonstrated that serum creatinine is not always a sensitive and specific test for renal dysfunction in patients undergoing CABG, because it depends on factors beyond renal function, such as age, sex, and muscle mass. Calculation of glomerular filtration rate by accepted methods, such as the Cockroft-Gault formula or the Modification of Diet in Renal Disease equations, appears to be superior to plain serum creatinine in the identification of renal dysfunction and the prediction of adverse outcomes after CABG.