The Use of Advanced Glycation End-Product Measurements to Predict Post-Operative Complications After Cardiac Surgery

Area of Science:

• Biomarkers in Surgery
• Geriatric Medicine
• Cardiovascular Research

Background:

• Frailty is a significant factor influencing outcomes in cardiac surgery.
• Current frailty assessments often rely on subjective measures, impacting reliability.
• Advanced glycation end products (AGEs) are potential objective biomarkers for frailty.

Purpose of the Study:

• To review the association between AGEs and surgical outcomes.
• To evaluate the utility of AGEs for objective frailty assessment.
• To explore the role of AGEs in preoperative risk stratification for cardiac surgery.

Main Methods:

• Systematic literature search across five databases (MEDLINE, Embase, Cochrane, ClinicalTrials.gov, Google Scholar).
• Inclusion criteria focused on English-language studies of adult surgical patients; exclusion of incomplete data.
• Analysis of 13 studies (2402 participants), categorized by surgery type, with quality assessed using ROBINS-I.

Main Results:

• A statistically significant association between AGE levels and post-operative complications/outcomes was found in four of five cardiac surgery studies.
• This association extended to thoracic and general surgery, correlating with complications and mortality.
• Pathophysiological mechanisms include AGEs-induced oxidative stress, inflammation, and endothelial dysfunction.

Conclusions:

• Evidence supports a link between AGE levels and cardiac surgical outcomes.
• AGEs represent a promising objective measure for frailty assessment.
• Objective frailty measurement using AGEs could enhance preoperative risk assessment and identify candidates for prehabilitation.