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Postgrad Med J 87:542-549 doi:10.1136/pgmj.2010.107177
  • Review

Biomarkers to guide perioperative management

  1. Gareth L Ackland2
  1. 1Centre for Anaesthesia, Critical Care and Pain Medicine, University College London Hospitals, University College London, London, UK
  2. 2Department of Medicine, Wolfson Institute for Biomedical Research, University College London, London, UK
  1. Correspondence to Dr Gareth L Ackland, Wolfson Institute for Biomedical Research, Cruciform Building (Wing 3.2), Department of Medicine, University College London, London WC1E 6BT, UK; g.ackland{at}ucl.ac.uk
  1. Contributors All authors contributed to the design and writing of the manuscript.

  • Received 7 October 2010
  • Accepted 9 December 2010
  • Published Online First 17 January 2011

Abstract

Stratifying preoperative risk and guiding perioperative therapy objectively has acquired critical importance, given robust data demonstrating that morbidity following non-cardiac surgery confers substantially increased risk of death, even beyond hospital discharge. The development of useful perioperative biomarkers depends fundamentally on both prospective morbidity data that enable the identification of higher risk patients as well as the translational understanding of pathophysiological mechanisms underlying postoperative organ dysfunction, the development of which may be specific to the perioperative environment. The emergence of cardiac insufficiency, rather than cardiac ischaemia, as the dominant factor associated with excess risk of prolonged postoperative morbidity has promoted the application of biomarkers used commonly in cardiovascular medicine. Several novel, organ specific biomarkers offer potential perioperative application. Nevertheless, common tests/biomarkers that are widely available do provide valuable, objective information that is perhaps under-utilised perioperatively. Despite significant challenges, perioperative medicine presents exciting—arguably unique—opportunities for novel biomarker development.

Footnotes

  • Linked articles 107185, 107169.

  • Funding Supported by Academy of Medical Sciences/Health Foundation Clinician Scientist Award (GLA); The Centre for Anaesthesia, Critical Care and Pain Management, University College London; HCA International Perioperative Clinical Research Fellowship (ME). This work was undertaken at University College London Hospitals NHS Trust/University College London who received a proportion of funding from the Department of Health UK NIHR Biomedical Research Centre funding scheme.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.