• Danica Z Markovic, Tatjana Jevtovic-Stoimenov, Milena Stojanovic, Anita Z Vukovic, Vesna Dinic, Bojana Z Markovic-Zivkovic, and Radmilo J Jankovic.
• General Surgery Clinic, Center for Anestesiology and Reanimatology, Clinical Center in Niš, Bulevar Dr Zorana Djindjica 48, Niš, 18000, Serbia. danica.markovic.1983@gmail.com.
• Aging Clin Exp Res. 2019 Sep 1; 31 (9): 1207-1217.

BackgroundOur previous research has shown American Society of Anaesthesiologists physical status classification (ASA) score and Americal College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator to have the most accuracy in the prediction of postoperative mortality.AimsThe aim of our research was to define the most reliable combination of cardiac biomarkers with ASA and ACS NSQIP.MethodsWe have included a total of 78 patients. ASA score has been determined in standard fashion, while we used the available interactive calculator for the ACS NSQIP score. Biomarkers BIRC5, H-FABP, and hsCRP have been measured in specialized laboratories.ResultsAll of the deceased patients had survivin (BIRC5) > 4.00 pg/ml, higher values of H-FABP and hsCRP and higher estimated levels of ASA and ACS NSQIP (P = 0.0001). ASA and ACS NSQIP alone had AUC of, respectively, 0.669 and 0.813. The combination of ASA and ACS NSQIP had AUC = 0.841. Combination of hsCRP with the two risk scores had AUC = 0.926 (95% CI 0.853-1.000, P < 0.0001). If we add three cardiac biomarkers to this model, we get AUC as high as 0.941 (95% CI 0.876-1.000, P < 0.0001). The correction of statistical models with comorbidities (CIRS-G score) did not change the accuracy of prediction models that we have provided.DiscussionAddition of ACS NSQIP and biomarkers adds to the accuracy of ASA score, which has already been proved by other authors.ConclusionCardiac biomarker hsCRP can be used as the most reliable cardiac biomarker; however, the "multimarker approach" adds the most to the accuracy of the combination of clinical risk scores.

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