Biomarkers in Anesthesia

Introduction to Biomarkers

  • Biomarkers are measurable indicators of biological states.
  • They are used for disease diagnosis, prognosis, and monitoring.
  • Biomarkers can be proteins, genes, enzymes, or structural changes.
  • They can be classified as markers of exposure or markers of disease.

Characteristics of an Ideal Biomarker

High sensitivity with organ specificityAccurate detection of organ-related changes.
Immediate release with tissue injuryRapid response to tissue damage.
Release proportional to insultThe extent of release correlates with the injury.
Long half-life for predictivenessSustained presence for predictive purposes.
Rapid decrease in concentration for monitoringQuick clearance for monitoring.
Rapid, simple, accurate, and inexpensive measurementEasy and cost-effective assessment.
Noninvasive and accessibleEasily obtainable without invasive procedures.

Biomarkers of the Cardiovascular System

BiomarkerDescriptionClinical Applications
C-reactive Protein (CRP)Marker of inflammation, linked to heart diseaseRisk assessment for coronary artery disease, rheumatoid arthritis, and lupus.
Cardiac TroponinsIndicators of heart muscle damageDiagnosis of myocardial infarction and risk assessment in patients with end-stage renal disease.
B-type Natriuretic Peptide (BNP)Reflects heart failureDiagnosis and prognosis in congestive heart failure.
Soluble Urokinase Plasminogen Activation Receptor (suPAR)Inflammation markerRisk prediction for cardiovascular disease.

Biomarkers of Kidney Injury

BiomarkerDescriptionClinical Applications
Neutrophil gelatinase-associated lipocalin (NGAL)Reflects kidney injuryEarly diagnosis and risk prediction of acute kidney injury.
N-Acetyl-b-D-Glucosaminidase (NAG)Enzyme found in kidney tubulesPrediction of renal replacement therapy in AKI patients.
Urinary cystatin C and Plasma cystatin CReflect kidney functionDiagnosis and prediction of AKI and assessment of glomerular filtration rate.
Kidney injury molecule-1 (KIM-1)Marker of kidney injuryPrediction of AKI and adverse outcomes.
Interleukin 18 (IL-18)Reflects inflammationPredicts death or AKI.

Biomarkers of Gut Failure

BiomarkerDescriptionClinical Applications
CitrullineMarker of enterocyte massIndicator of enterocyte damage and bacterial translocation.
Fatty Acid-binding Protein (I-FABP)Reflects intestinal epithelium damageEarly detection of intestinal injury.
Procalcitonin (PCT)Pro-inflammatory markerDifferentiates bacterial from viral infections and guides antibiotic use.
MicroRNA (miRNA)RNA molecules reflecting cellular changesPotential for diagnosing various disorders and sepsis.

Biomarkers of Brain Damage and POCD

BiomarkerDescriptionClinical Applications
S100B proteinFound in astroglial Schwann cellsUsed in detecting brain damage in surgery and trauma.
Metalloproteinases (MMP)Reflects blood-brain barrier dysfunctionAssociated with postoperative cognitive dysfunction (POCD).
Α-II Spectrin Breakdown Product (SBDP) 145,150,120Reflects neuronal injuryPotential marker for traumatic brain injury.


  • Biomarkers play a crucial role in diagnosing and monitoring various medical conditions.
  • While promising, their accuracy and clinical relevance may vary.
  • More research is needed to validate the use of newer biomarkers in clinical practice.


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