Preoperative C-Reactive Protein Predicts Early Postoperative Outcomes after Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension

Abstract

Purpose Patients with chronic thromboembolic pulmonary hypertension (CTEPH) display features of systemic inflammation. This study assesses whether high preoperative C-reactive protein (CRP) levels are associated with in-hospital outcomes after pulmonary endarterectomy. Methods This study included 159 patients who underwent pulmonary endarterectomy from 2009 to 2013 (derivation cohort) and 238 patients from 2015 to 2016 (validation cohort) from the French national CTEPH registry. The correlations between pro-inflammatory markers (CRP, interleukins 1 and 6, fibrinogen and leukocytes) and hemodynamics were assessed in the derivation cohort. Pre-, perioperative characteristics and 30-day outcomes (primary endpoint: death or lung transplant or extracorporeal membrane oxygenation need or inotropic or vasopressor need more than 2 days) of patients with high or low CRP levels were compared. Results Median age of the derivation cohort was 63 [52-73] years with 48% of female, 80% in NYHA class III/IV. CRP levels moderately correlated with fibrinogen, interleukin-6 and neutrophils count (r range 0.28-0.47). The validation cohort had similar demographics and disease severity. Patients with high CRP had higher resistance levels and lower cardiac index than those with low CRP in both cohorts. The primary endpoint was reached in 38% (derivation) and 42% (validation) of patients. In multivariable logistic regression analysis, CRP higher than 10 mg/L was associated with the primary endpoint in both the derivation cohort (odd ratio = 2.49 [1.11-5.61], independently of NYHA class IV and aortic clamping duration) and the validation cohort (odd ratio = 1.89 [1.09-3.61], independently of age and aortic clamping duration). Conclusion Preoperative CRP level higher than 10 mg/L is independently associated with adverse early outcomes after pulmonary endarterectomy.