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Despite recent advances, coronary artery bypass grafting (CABG) is still associated with adverse outcomes in patients with renal dysfunction both in the short term and in the long term, even when it is subclinical. Serum biomarkers, such as serum creatinine, enhance the identification of high-risk patients and thus may further facilitate targeting of interventions to optimize outcome after CABG. In fact, elevated serum creatinine has already been integrated into standard cardiac surgical risk calculators, such as the Society of Thoracic Surgeons PROM score and the EuroSCORE. Recent evidence, however, has demonstrated that serum creatinine is not always a sensitive and specific test for renal dysfunction in patients undergoing CABG, because it depends on factors beyond renal function, such as age, sex, and muscle mass. Calculation of glomerular filtration rate by accepted methods, such as the Cockroft-Gault formula or the Modification of Diet in Renal Disease equations, appears to be superior to plain serum creatinine in the identification of renal dysfunction and the prediction of adverse outcomes after CABG. In fact, the detection of renal injury in patients undergoing CABG is further enhanced by looking beyond both serum creatinine and calculated creatinine clearance. Recent evidence points to preoperative proteinuria as an independent predictor for adverse outcomes after CABG, including acute renal dysfunction, dialysis, and prolonged stays both in the intensive care unit and in the hospital. This ongoing clinical refinement of serum creatinine as an outcome biomarker for CABG resembles recent progress in the world of myocardial biomarkers. The clinical utility of creatine kinase MB has been further enhanced by such biomarkers as troponin and heart-type fatty acid–binding protein. Despite these limitations of serum creatinine as an outcome biomarker in cardiac surgery, it remains important.

journal of thoracic and cardiovascular surgery

Serum creatinine as a perioperative biomarker: A challenge for perioperative management and an opportunity for the Cardiothoracic Surgery Trials Network