title: Preoperative C-reactive protein predicts long-term mortality and hospital length of stay after primary, nonemergent coronary artery bypass grafting.
abstract: BACKGROUND
  Preoperative C-reactive protein (CRP) levels more than 10 mg/l have been shown to be associated with increased morbidity and mortality after cardiac surgery. We examine the value of preoperative CRP levels less than 10 mg/l for predicting long-term, all-cause mortality and hospital length of stay in surgical patients undergoing primary, nonemergent coronary artery bypass graft-only surgery.
  
  
  METHODS
  We examined the association between preoperative CRP levels stratified into four categories (< 1, 1-3, 3-10, and > 10 mg/l), and 7-yr all-cause mortality and hospital length of stay in 914 prospectively enrolled primary, nonemergent coronary artery bypass graft-only surgical patients using a proportional hazards regression model.
  
  
  RESULTS
  Eighty-seven patients (9.5%) died during a mean follow-up period of 4.8 +/- 1.5 yr. After proportional hazards adjustment, the 3-10 and > 10 mg/l preoperative CRP groups were associated with long-term, all-cause mortality (hazards ratios [95% CI]: 2.50 [1.22-5.16], P = 0.01 and 2.66 [1.21-5.80], P = 0.02, respectively) and extended hospital length of stay (1.32 [1.07-1.63], P < 0.001 and 1.27 [1.02-1.62], P = 0.001, respectively).
  
  
  CONCLUSIONS
  We demonstrate that preoperative CRP levels as low as 3 mg/l are associated with increased long-term mortality and extended hospital length of stay in relatively lower-acuity patients undergoing primary, nonemergent coronary artery bypass graft-only surgery. These important findings may allow for more objective risk stratification of patients who present for uncomplicated surgical coronary revascularization.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. tperry@partners.org
authors.forename: Tjörvi E
authors.initials: TE
authors.lastname: Perry
authors.forename: Jochen D
authors.initials: JD
authors.lastname: Muehlschlegel
authors.forename: Kuang-Yu
authors.initials: KY
authors.lastname: Liu
authors.forename: Amanda A
authors.initials: AA
authors.lastname: Fox
authors.forename: Charles D
authors.initials: CD
authors.lastname: Collard
authors.forename: Simon C
authors.initials: SC
authors.lastname: Body
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
mesh_terms: D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism*; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011237:Predictive Value of Tests; D057234:Preoperative Period; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D002097:C-Reactive Protein