Biomarkers and Inflammatory Responses in Cardiac Surgery

Cardiac surgery prompts a multifaceted inflammatory cascade driven by surgical trauma, blood–material interactions during cardiopulmonary bypass and ischaemia–reperfusion injury. This response involves activation of complement, coagulation and endothelial pathways, leading to release of cytokines, acute-phase proteins and oxidative mediators. Biomarkers such as procalcitonin, C-reactive protein and interleukin-6 reflect the magnitude of systemic inflammation, whereas natriuretic peptides and pro-adrenomedullin provide insight into haemodynamic stress and vascular integrity. Oxidative stress markers, notably isoprostanes, indicate lipid peroxidation and correlate with postoperative organ dysfunction. Precise measurement of these molecules aids in distinguishing normal postoperative inflammation from infection, predicting complications such as prolonged ventilation or renal injury, and guiding tailored anti-inflammatory or antibiotic strategies. Emerging panels combining cellular, protein and oxidative biomarkers hold promise for real-time risk stratification and enhanced patient outcomes.

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Biomarkers and Inflammatory Responses in Cardiac Surgery publication trend

The graph below shows the total number of articles in biomarkers and inflammatory responses in cardiac surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Procalcitonin: A peptide precursor of calcitonin that rises in response to bacterial infection and systemic inflammation, used to distinguish septic from non-septic inflammatory states.

Cardiopulmonary bypass (CPB): A technique that temporarily takes over heart and lung function during surgery, involving extracorporeal circulation and exposure of blood to artificial surfaces.

Systemic inflammatory response syndrome (SIRS): A clinical condition characterised by two or more findings among fever or hypothermia, tachycardia, tachypnoea and abnormal leukocyte count, reflecting widespread inflammatory activation.

Isoprostanes (8-iso-PGF2α): Stable prostaglandin-like compounds generated by oxidative peroxidation of arachidonic acid, serving as reliable markers of in vivo lipid oxidation and oxidative stress.

References

1. Postoperative Serum Procalcitonin Level Can Be a Useful Marker of Bacterial Infection after Cardiac Surgery Utilizing Cardiopulmonary Bypass. Journal of Cardiac Surgery (2024).
2. Infection…what else? The usefulness of procalcitonin in children after cardiac surgery. PLOS ONE (2021).
3. Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes. PLOS ONE (2021).