title: Preoperative increasing C-reactive protein affects the outcome for active infective endocarditis.
abstract: OBJECTIVE
  This study aimed to determine if preoperative time course changes in serum C-reactive protein (CRP) levels can predict clinical outcome of surgical intervention for active infective endocarditis.
  
  
  METHODS
  Surgically treated patients (n = 109) with active infective endocarditis were reviewed retrospectively. We divided the patients into 2 subgroups according to preoperative transition of increasing or decreasing serum CRP levels, and performed a comparative study. The increasing CRP group included 29 patients and the decreasing CRP group included 80 patients.
  
  
  RESULTS
  There were more patients with methicillin-resistant Staphylococcus aureus and New York Heart Association functional class IV in the increasing CRP group. Hospital mortality was significantly higher in the increasing CRP group (34.5%) than that in the decreasing CRP group (5.0%) (p <0.05). In multivariate analysis, 3 significant risk factors of surgical outcome were identified: a tendency for increasing preoperative CRP levels (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 1.03-320.78), nosocomial infective endocarditis (OR: 18.73, 95% CI: 1.57-223.60), and dialysis (OR: 1025.46, 95% CI: 2.89-363587.12).
  
  
  CONCLUSIONS
  The outcome of operations for patients with increasing preoperative CRP levels is poor. For treatment of active infective endocarditis, a better operative result is expected when preoperative CRP levels are decreasing.
authors: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors: Yuko
authors: Y
authors: Okada
authors: Mitsuharu
authors: M
authors: Hosono
authors: Yasuyuki
authors: Y
authors: Sasaki
authors: Hidekazu
authors: H
authors: Hirai
authors: Shigefumi
authors: S
authors: Suehiro
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003428:Cross Infection / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein