Preoperative C-reactive protein levels to predict early and late mortalities after coronary artery bypass surgery: Eight years of follow-up
Received 10 December 2008; received in revised form 23 March 2009; accepted 29 March 2009. published online 24 June 2009.
Objective
There is limited evidence that increased preoperative levels of C-reactive protein are associated with increased mortality after coronary artery bypass grafting. We retrospectively investigated in 5669 patients the predictive value of preoperative C-reactive protein levels for early and late mortalities after coronary artery bypass grafting.
Methods
Patients undergoing isolated coronary artery bypass grafting between January 2000 and December 2007 (n = 8500) were studied. Preoperative demographic data and risk factors and outcome data (mortality data) were prospectively collected in a database. Preoperative C-reactive protein levels were retrieved from the laboratory data.
Results
In 5669 of 8500 cases, the preoperative C-reactive protein level could be retrieved. Seventy-five patients were unavailable for follow-up. A preoperative C-reactive protein level greater than 10 mg/L was an independent risk factor for early mortality, whereas a level greater than 5 mg/L was a risk factor for late mortality. Other risk factors were age, sex, chronic obstructive pulmonary disease, diabetes, left ventricular ejection fraction less than 35%, peripheral vascular disease, and previous cardiac surgery. We found a higher mean C-reactive protein value in patients with a left ventricular ejection fraction less than 35% (18.5 ± 33 mg/L) than in those with an ejection fraction greater than 35% (P < .0001).
Conclusions
Preoperative C-reactive protein levels can be used in risk stratification in coronary artery bypass grafting surgery. A C-reactive protein level greater than 10 mg/L is a risk factor for early mortality, whereas a level greater than 5 mg/L is a risk factor for late mortality.
aDepartment of Cardio-Thoracic Surgery, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
bDepartment of Anesthesiology, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
cDepartment of Education and Research, Catharina Hospital–Brabant Medical School, Eindhoven, The Netherlands
dDepartment of Anesthesiology, University Hospital Ghent, Ghent, Belgium
eCenter of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
fDepartment of Anesthesiology, The Feinberg School of Medicine, Northwestern University, Chicago, Ill
Address for reprints: Mohamad A. Soliman Hamad, MD, Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602 ZA Eindhoven, The Netherlands.
ABSTRACT