Association between Preoperative C-Reactive Protein Levels with Postoperative Complications of Cardiovascular Surgery

pp. 492-498

Abstract

Background: Systemic inflammatory response syndrome is a frequent complication in the postoperative of cardiac surgery, which can evolve with vasoplegic shock and the most severe cases can end in the failure of one or more organs. Predictors in the preoperative, perioperative associated with this complication have been described; however, a subclinical inflammation state in the preoperative, not detected by routine tests, could be related to the inflammatory response occurred in the postoperative. High levels of C-reactive protein (CRP), an inflammation parameter in different clinical scenes and which is associated with the prognosis of different cardiovascular pathologies, may predict the syndrome.
Objective: To evaluate the contribution of preoperative elevated levels of C-reactive protein to predict systemic inflammatory response syndrome and its postoperative complications in cardiac surgery.
Material and Methods: A total of 169 consecutive patients, (male 77.3%, age 61.1±15.9, EuroSCORE 9.46 [SD 12.7]) undergoing cardiac surgery between April 2007 and December 2008 were prospectively included. The level of CRP was determined in all the patients. The combined endpoint included systemic inflammatory response syndrome and its association with atrial fibrillation, renal failure, shock or death.
Results: Eighty-seven patients (54%) developed systemic inflammatory response syndrome and 50 patients (31%) showed combined endpoint. Hospital mortality was of 5.6% (9 patients). Adjusted by preoperative and intraoperative variables, preoperative levels of CRP ≥2 mg/dl were associated with the combined endpoint (OR 2.95, HF 95% 1.20-7.23; p<0.018), with the evolution of systemic inflammatory response syndrome (SIRS) (OR 5.10, HF 95% 1.48-17.58; p<0.010), combined SIRS with shock (OR 6.50, HF 95% 4.59-27.34; p<0.005), combined SIRS with atrial fibrillation (OR 3.51, HF 95% 1.14-10.79; p<0.028), renal failure (OR 2.91, HF 95% 1.19-7.12; p<0.019) and shock (OR 4.13, HF 95% 1.25-13.6; p<0.020).
Conclusions: The criterion of adaptation of coronary revascularization (percutaneous or surgical) in a high complexity cardiovascular center was inappropriate in a minority of cases. Such criterion is a potentially applicable tool both in the decision-making in those patients with coronary disease and in the control of quality of cardiology departments.