EMERGING BIOMARKERS AT THE CROSSROADS OF CARDIAC, RENAL, AND HEPATIC DYSFUNCTION: A NEW ERA IN MULTIORGAN RISK STRATIFICATION
Keywords:
Oxidative stress, extracellular matrix remodeling, fibrosis, heart failure, neurohumoral activation, acute kidney injury, cardio-hepato-renal dysfunctionAbstract
The cardio-hepato-renal axis represents a complex interplay of organ systems whose dysfunction contributes to high morbidity and mortality in chronic disease. Traditional biomarkers such as natriuretic peptides, creatinine, and liver transaminases provide limited insight into the early and overlapping pathophysiological changes within this tri-organ network. Emerging biomarkers - including ischemia-modified albumin (IMA), soluble ST2 (sST2), galectin-3, thrombin–antithrombin complex (TAT), neutrophil gelatinase-associated lipocalin (NGAL), hyaluronic acid (HA), and matrix metalloproteinase-9 (MMP-9) - offer novel perspectives by reflecting oxidative stress, myocardial fibrosis, neurohumoral activation, coagulation activity, renal tubular injury, extracellular matrix remodeling, and systemic inflammation. This review synthesizes current evidence on the mechanistic relevance, diagnostic performance, and prognostic value of these biomarkers across diverse clinical contexts such as acute coronary syndromes, heart failure, atrial fibrillation, sepsis, and cardio-hepato-renal syndrome. We highlight their potential integration into multimarker panels and precision medicine strategies, emphasizing their role in early detection, risk stratification, and therapeutic monitoring. By shifting from isolated organ assessment to systemic biomarker profiling, these tools may transform clinical practice, enabling more holistic management of multiorgan dysfunction and improving patient outcomes.
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Copyright (c) 2026 Marija Vavlukis, Dusan Petkovski, Slavce Todorovski, Elif Vranjko, Amela Dobjani, Melina Kuzmanovska Dimitrovski, Natasa Taneska Canoska, Stojan Mitreski, Gordana Donevska, Lidija Poposka, Julija Zivadinovik
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