Preoperative Clinical Factors Are Important Determinants of the Inflammatory State Before and After Heart Surgery

Abstract

Postoperative inflammatory response is common in heart surgery patients, but less is known about variation in the baseline inflammatory state. This study characterizes the preoperative inflammatory profile in a group of high- and low-risk patients (n = 32; male 16, female 16; mean age, 70.3 +/- 1.8) and relates this to postoperative events. Interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha, TNF receptors (R1 and R2), and high-sensitivity C-reactive protein were measured before surgery and 4 hours after arrival in the intensive care unit. Considerable variability existed in all preoperative inflammatory mediators before surgery. Patients with an elevated baseline IL-6 level, (IL-6 >10 pg/mL) were older (73.5 +/- 2.2 vs. 67.9 +/- 2.6 years), had a lower ejection fraction (34 +/- 3.8% vs. 44 +/- 2.9%), a higher predicted risk score (10.3 +/- 1.2 vs. 5.9 +/- 1.1), and a higher baseline high-sensitivity C-reactive protein (65 +/- 10 vs. 24 +/- 6 mg/L), p < 0.05 for all. These patients had high morbidity and mortality rates after surgery. In addition, patients judged to be at high risk on clinical criteria were found to have consistent elevations in the baseline inflammatory state. All patients had a surge in inflammatory mediators after surgery, but those who started at a higher baseline reached a higher postoperative level than the others (IL-6 2023 +/- 561 vs. 361 +/- 47 pg/mL, p < 0.05). Many heart surgery patients, especially higher-risk patients, have a significant inflammatory state before surgery. These patients are at risk for high morbidity and mortality rates after surgery.