Systemic inflammation and repair of abdominal aortic aneurysm.
BACKGROUND
Inflammation is integral to the pathogenesis of abdominal aortic aneurysm (AAA). This study examines preoperative biomarkers of systemic inflammation in patients undergoing open repair of intact and ruptured AAA.


METHODS
One-hundred twelve patients were entered into a prospective observational study. Preoperative POSSUM physiology score, C-reactive protein (CRP), white blood count (WBC), platelet count, fibrinogen, and albumin were recorded and related to clinical variables using univariate analysis.


RESULTS
Sixty-one patients with a ruptured AAA, 39 with an asymptomatic intact AAA, and 12 with an acutely symptomatic intact AAA underwent attempted repair. There were two inflammatory asymptomatic aneurysms and one inflammatory ruptured aneurysm. No patient had clinical evidence of coexistent inflammatory disease. Patients with a symptomatic intact AAA had a significantly greater level of CRP and fibrinogen, higher WBC, and lower serum albumin, than those with an asymptomatic intact AAA. Patients with a ruptured aneurysm had a significantly greater level of CRP, higher WBC, and lower serum albumin than those with an asymptomatic intact aneurysm. Patients with a symptomatic intact AAA had a significantly higher CRP level, but lower WBC, than those with a ruptured AAA. There was no difference in CRP level, WBC, or serum albumin between survivors and non-survivors of attempted repair of asymptomatic, symptomatic and ruptured AAA.


CONCLUSIONS
Acutely symptomatic and ruptured AAAs are associated with an early elevation in systemic inflammatory biomarkers. This early activation of the inflammatory response might influence perioperative outcome.
Tambyraja
Andrew L
AL
Edinburgh Vascular Surgical Service, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland. andrew.tambyraja@ed.ac.uk
Dawson
Raymond
R
Valenti
Domenico
D
Murie
John A
JA
Chalmers
Roderick T
RT
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D001025:Aortitis / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D002097:C-Reactive Protein / Q000378:metabolism*; D002423:Cause of Death; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D017052:Hospital Mortality; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D012709:Serum Albumin / Q000378:metabolism*; D012720:Severity of Illness Index
D012709:Serum Albumin; D005340:Fibrinogen; D002097:C-Reactive Protein