C-Reactive protein and inflammatory response associated to neurocognitive decline following cardiac surgery.
BACKGROUND
It has been recognized that neurocognitive decline (NCD) often occurs as a complication in cardiac surgery. The early inflammatory response and C-reactive protein (CRP) was examined in relation to NCD and to a marker of axonal central nervous system (CNS) injury after cardiopulmonary bypass.


METHODS
A cohort of patients undergoing coronary artery bypass grafting and/or valve procedures using cardiopulmonary bypass were administered a neurocognitive battery preoperatively and postoperatively at 6 hours and day 4. CRP, interleukin 1 beta, and interleukin 10 were quantified from serum. Increase of serum tau protein after surgery was used as a marker of axonal CNS damage.


RESULTS
The rate of NCD was found to be 40.5% in this group. Surprisingly, known predictors of NCD did not differ significantly between patients with/without NCD. Patients with NCD had an early increase of CRP of a significantly higher magnitude than those without NCD (38.01 +/- 11.4 vs 16.49 +/- 3.5 mg/L, P = .042), interleukin 1ss (2.35 +/- 0.3 vs 1.20 +/- 0.2 pg/mL, P = .002), and interleukin 10 (29.77 +/- 4.7 vs 12.94 +/- 2.2 pg/mL, P < .001). Increase in serum Tau protein was significantly correlated to NCD (r = 0.50, P = .02).


CONCLUSIONS
Perioperative increases in CRP and inflammatory cytokines are associated with NCD in patients after cardiopulmonary bypass. Thus, it appears that inflammation plays a key role in NCD pathophysiology, likely via axonal CNS injury, and could become a target for prevention.
Ramlawi
Basel
B
Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Rudolph
James L
JL
Mieno
Shigetoshi
S
Feng
Jun
J
Boodhwani
Munir
M
Khabbaz
Kamal
K
Levkoff
Sue E
SE
Marcantonio
Edward R
ER
Bianchi
Cesario
C
Sellke
Frank W
FW
D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003072:Cognition Disorders / Q000097:blood* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D008297:Male; D008875:Middle Aged; D016875:tau Proteins / Q000097:blood
D007375:Interleukin-1; D016875:tau Proteins; D016753:Interleukin-10; D002097:C-Reactive Protein