Association between Preoperative C-Reactive Protein Levels with Postoperative Complications of Cardiovascular Surgery

Abstract

Background Systemic inflammatory response syndrome is a frequent postoperative complication of cardiovascular surgery that can develop vasoplegic shock and organ or multiorgan dysfunction in the most severe cases. Preoperative and postoperative predictors associated with this complication have been described; however, a subclinical preoperative inflammatory state, not detected by routine tests, might be related to the postoperative inflammatory response. Elevated C-reactive protein (CRP) levels, a parameter of inflammation in different clinical scenarios that is associated with the prognosis of diverse cardiovascular diseases, might predict the syndrome. Objective To evaluate the value of elevated C-reactive protein to predict systemic inflammatory response syndrome and its postoperative complications after cardiovascular surgery. Material and Methods A total of 169 consecutive patients (77.3% were men, age 61.1±15.9, Euroscore 9.46 [SD 12.7]) undergoing cardiovascular surgery were prospectively included between April 2007 and December 2008. CRP levels were determined in all patients. The combined endpoint included the incidence of systemic inflammatory response syndrome and its association with atrial fibrillation, kidney failure, shock or death. Results Eighty seven patients (54%) developed systemic inflammatory response syndrome and 50 patients (31%) presented the combined endpoint. In-hospital mortality was 5.6% (9 patients). The preoperative levels of CRP ≥2 mg/dl adjusted for preoperative and postoperative variables were independently associated with the combined endpoint (OR 2.95, 95% CI 1.20-7.23; p<0.018), with the development of systemic inflammatory response syndrome (SIRS) (OR 2.46, 95% CI 1.17-5.15; p<0.000), and with the combination of SIRS and kidney failure (OR 5.10, 95% CI 1.48-17.58; p<0.010), SIRS and shock (OR 6.50, 95% CI 1.59-27.34; p<0.005), and SIRS kidney failure (OR 2.91, 95% CI 1.19-7.12; p<0.019) and shock (OR 4.13, 95% CI 1.25-13.60; p < 0.020). Conclusions Preoperative levels of CRP ≥2.0 mg/dl may predict the systemic inflammatory response syndrome and the systemic inflammatory response syndrome with kidney failure, atrial fibrillation, shock and death in the postoperative period of cardiovascular surgery.