Preoperative C-reactive protein predicts mid-term outcome after cardiac surgery.
BACKGROUND
C-reactive protein (CRP) is a known risk factor for cardiovascular events in the healthy population and in patients with coronary artery disease. High CRP levels before cardiac surgery are associated with worse short-term outcome, but its role after discharge home remains unknown. The study objective was to evaluate the effect of CRP on short-term and mid-term outcome after cardiac surgery.


METHODS
From August 2000 to May 2004, values for preoperative CRP were available for 597 unselected patients undergoing cardiac operations. CRP was used to divide this cohort in two groups: a low inflammatory status (LHS) group of 354 patients with CRP of less than 0.5 mg/dL, and a high inflammatory status (HIS) group of 243 patients with a CRP of 0.5 mg/dL or more. Follow-up lasted a maximum of 3 years (median, 1.8 +/- 1.5 years) and was 92.6% complete.


RESULTS
In-hospital mortality was 8.2% in the HIS group and 3.4% in the LIS group (odds ratio [OR], 2.61; p = 0.02). Incidence of postoperative infections was 16.5% in the HIS group and 5.1% in the LIS group (OR, 3.25; p = 0.0001). Sternal wound infections were also more frequent in the HIS group (10.7% versus 2.8%; OR, 3.43; p = 0.002). During follow-up, the HIS group had worse survival (88.5% +/- 2.9% versus 91.9% +/- 2.5%; OR, 1.93; p = 0.05) and a higher need of hospitalization for cardiac-related causes (73.6% +/- 6% versus 86.5% +/- 3.2%; OR, 1.82; p = 0.05).


CONCLUSIONS
Patients undergoing cardiac surgery with a CRP level of 0.5 mg/dL or more are exposed to a higher risk of in-hospital mortality and postoperative infections. Despite surgical correction of cardiac disease, a high preoperative CRP value is an independent risk factor for mid-term survival and hospitalization for cardiac causes.
Cappabianca
Giangiuseppe
G
Division of Cardiac Surgery, Dipartimento d'Emergenza e Trapianti d'Organo, University of Bari, Bari, Italy.
Paparella
Domenico
D
Visicchio
Giuseppe
G
Capone
Giuseppe
G
Lionetti
Giosuè
G
Numis
Flora
F
Ferrara
Pietro
P
D'Agostino
Chiara
C
de Luca Tupputi Schinosa
Luigi
L
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D002097:C-Reactive Protein