Perfüzyon Pratiğinde Biyobelirteçler: Güncel Yaklaşımlar ve Klinik Perspektifler

Mehmet Ramat; Mahmut Padak

doi:10.5281/zenodo.18103813

Authors

Mehmet Ramat Harran University https://orcid.org/0000-0003-4922-6708
Mahmut Padak Harran University, Institute of Health Sciences, Department of Perfusion Technologies, Şanlıurfa, Turkey https://orcid.org/0000-0001-6863-1907

DOI:

https://doi.org/10.5281/zenodo.18103813

Keywords:

Cardiopulmonary Bypass, Biomarkers, Endothelial Glycocalyx, Acute Kidney Injury, Viscoelastic Testing

Abstract

Objective: To holistically evaluate the clinical significance of endothelial, renal, neurological, myocardial, inflammatory, and hemostasis biomarkers associated with hemodilution, ischemia-reperfusion injury, and systemic inflammatory response during and after cardiopulmonary bypass (CPB) in light of current evidence; to demonstrate their contribution to risk stratification and personalized therapy.

Materials and Methods: A review of current literature on the subject was conducted, and clinical studies and reviews examining the diagnostic/predictive value of biomarkers (endothelial glycocalyx products, renal injury markers, neurospecific proteins, cardiac markers, and hemostasis indicators) in patients undergoing CPB were comparatively evaluated. Studies examining the integration of single-biomarker-based approaches with panel/multimarker and point-of-care (TEG/ROTEM) functional testing were particularly considered.

Results: Biomarkers in CPB reveal multiaxial interactions: Endothelial glycocalyx degradation products (especially syndecan-1) reflect vascular barrier disruption and the risk of capillary leak, while in the renal axis, NGAL and TIMP-2·IGFBP7 can predict acute kidney injury at an earlier stage compared to serum creatinine. In neurological involvement, S100B, NSE, and GFAP stand out as neurospecific indicators indicating postoperative cognitive impairment and delirium risk. In the assessment of myocardial stress and prognosis, high-sensitivity troponins and NT-proBNP exhibit strong predictive value; in the balance of hemostasis, D-dimer, thrombin-antithrombin (TAT) complexes, and viscoelastic tests (TEG/ROTEM) provide complementary information in the management of bleeding-thrombosis. However, decision-making based on a single marker remains inadequate due to specificity and timing limitations; Integrating panel-based assessments with point-of-care functional tests offers a more reliable and clinically relevant approach.

Discussion and Conclusion: Biomarkers in CPB practice have significant potential for early complication detection, risk stratification, and treatment personalization. Integrating functional tests such as TEG/ROTEM with panel-based approaches that monitor endothelial, renal, neurological, cardiac, and hemostatic axes together reduces the limitations of single-marker-based decisions and increases clinical accuracy. Systematic integration into routine perfusion practice may enable earlier and more targeted management of capillary leak, AKI, neurocognitive impairment, cardiac dysfunction, and bleeding/thrombosis imbalance. However, establishing standardized thresholds and conducting large-scale, multicenter clinical trials are necessary to ensure the generalizability of the findings and their full translation into clinical practice.

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