The Preoperative Inflammatory Status Affects the Clinical Outcome in Cardiac Surgery.

Castellaneta Castellaneta,Mastro Mastro,Charitos Charitos,Rotunno Rotunno,Cappabianca Cappabianca,Carrozzo Carrozzo,Quagliara Quagliara,D’agostino D’Agostino,Beghi Beghi

doi:10.3390/antibiotics8040176

Abstract

Aims: There are many reasons for the increase in post-operative mortality and morbidity in patients undergoing surgery. In fact, an activated inflammatory state before cardiac surgery, can potentially worsen the patient’s prognosis and the effects of this preoperative inflammatory state in the medium-term remains unknown. Methods: There were 470 consecutive patients who underwent cardiac surgery, and were divided in three groups according to the median values of preoperative C-reactive protein (CRP) and fibrinogen (FBG): The first group was the low inflammatory status group (LIS) with 161 patients (CRP < 0.39 mg/dL and FBG < 366 mg/dL); the second was the medium inflammatory status group (MIS) with 150 patients (CRP < 0.39 mg/dL and FBG ≥ 366 mg/dL or CRP ≥ 0.39 mg/dL and FBG < 366 mg/dL,); and the third was the high inflammatory status group (HIS) with 159 patients (CRP ≥ 0.39 mg/dL and FBG ≥ 366 mg/dL,). Results: The parameters to be considered for the patients before surgery were similar between the three groups except, however, for age, left ventricular ejection fraction (LVEF) and the presence of arterial hypertension. The operative mortality was not significantly different between the groups (LIS = 2.5%, MIS = 6%, HIS = 6.9%, p = 0.16) while mortality for sepsis was significantly different (LIS = 0%, MIS = 1.3%, HIS = 3.7%, p = 0.03). The infections were more frequent in the HIS group (p = 0.0002). The HIS group resulted in an independent risk factor for infections (relative risk (RR) = 3.1, confidence interval (CI) = 1.2–7.9, p = 0.02). During the 48-months follow-up, survival was lower for the HIS patients. This HIS group (RR = 2.39, CI = 1.03–5.53, p = 0.05) and LVEF (RR = 0.96, CI = 0.92–0.99, p = 0.04) resulted in independent risk factors for mortality during the follow-up. Conclusions: The patients undergoing cardiac surgery with a preoperative highly activated inflammatory status are at a higher risk of post-operative infections. Furthermore, during the intermediate follow-up, the preoperative highly activated inflammatory status and LVEF resulted in independent risk factors for mortality.

Highlights

Heart disease, including coronary artery disease and heart valve disease, is often associated with underlying and an unrecognised inflammatory status
The aim of this study is to evaluate the effects of the preoperative inflammatory status on a 48-month follow-up after cardiac surgery
After an initial drop probably caused by hemodilution, the fibrinogen peak values were observed in the third post-operative day

Summary

Introduction

Heart disease, including coronary artery disease and heart valve disease, is often associated with underlying and an unrecognised inflammatory status. C-reactive protein (CRP) and fibrinogen (FBG) seem to be the most significantly associated with cardiovascular events [1]. Degenerative aortic stenosis has been recognized as an inflammatory disease with several histological analogies with coronary atherosclerosis [9]. Many authors have demonstrated that the patients with calcific aortic stenosis have increased CRP plasma levels which decrease after native valve replacement [10,11]. The high plasma levels of CRP are common in patients with chronic rheumatic valve disease [12] and significantly predict the outcome after percutaneous balloon mitral valve commissurotomy [13]

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Discussion

Conclusion