Abstract
<title>Abstract</title> <p> <bold>Background</bold> Early troponin elevation and creatinine-defined renal injury after transcatheter aortic valve replacement (TAVR) are usually evaluated as separate organ-specific complications. Whether routine preprocedural laboratory abnormalities can identify a shared systemic vulnerability to early postprocedural myocardial or renal biomarker injury remains unclear. <bold>Methods</bold> This retrospective single-center cohort study enrolled patients undergoing TAVR with complete preoperative laboratory measurements and early postoperative troponin T or creatinine data. A four-item biomarker burden score, assigning one point for each abnormal parameter: albumin < 40 g/L, D-dimer > 0.5 mg/L, lymphocyte count < 1.0 × 10⁹/L, and fibrinogen-to-albumin ratio > 0.10. The primary endpoint was early biomarker-defined cardiorenal injury, defined as either substantial postoperative troponin T elevation or creatinine-defined early renal injury. Multivariable logistic regression assessed composite and organ-specific endpoints, and a stacked model formally compared myocardial and renal effect estimates. <bold>Results</bold> The adjusted analysis included 1,259 patients, of whom 221 (17.6%) developed the primary endpoint. Event rates increased from 10.8% at score 0 to 34.3% at score 4. Each one-point increase was associated with the composite endpoint (adjusted odds ratio [OR] 1.24, 95% confidence interval [CI] 1.09–1.40; P < 0.001), troponin elevation (OR 1.17, 95% CI 1.02–1.34; P = 0.023), and renal injury (OR 1.42, 95% CI 1.15–1.77; P = 0.001). Higher baseline burden remained associated with lower postprocedural albumin and lymphocyte count and higher D-dimer and fibrinogen-to-albumin ratio (all postprocedural score gradients P < = 0.002). The renal association was directionally stronger than the troponin association, although formal heterogeneity was not statistically significant (P = 0.076). <bold>Conclusions</bold> Preprocedural inflammatory, nutritional, and coagulation biomarker burden was independently associated with early biomarker-defined cardiorenal injury after TAVR. This multidomain vulnerability framework warrants prospective validation with standardized serial biomarker assessment. </p>