Novel Biomarkers for Early Detection of Perioperative Organ Dysfunction

Organ dysfunction after major surgery is often diagnosed late, once creatinine, troponin, or a cognitive or respiratory criterion has already crossed a threshold, by which point the injury is established and the window for prevention has closed. This review surveys biomarkers proposed to detect perioperative organ dysfunction earlier: urinary TIMP-2/IGFBP7 and neutrophil gelatinase-associated lipocalin for acute kidney injury, high-sensitivity troponin and natriuretic peptides for myocardial injury after noncardiac surgery, neurofilament light chain and glial fibrillary acidic protein for postoperative delirium, and epithelial and inflammatory markers for postoperative pulmonary complications. Troponin surveillance for myocardial injury and urinary cell-cycle arrest markers for kidney injury risk stratification have progressed furthest toward routine use, while neuronal and pulmonary injury markers remain largely confined to research. Across every organ system, combining biomarkers with clinical and intraoperative exposure data consistently improves prediction over any single marker, underscoring that perioperative organ injury is multifactorial rather than attributable to one pathway. We conclude that biomarker discovery has outpaced implementation science, and that pragmatic trials randomizing patients to biomarker-triggered pathways are the necessary next step toward better outcomes.