Preoperative C-reactive Protein Predicts Long-term Mortality and Hospital Length of Stay after Primary, Nonemergent Coronary Artery Bypass Grafting

Preoperative C-reactive protein (CRP) levels more than 10 mg/l have been shown to be associated with increased morbidity and mortality after cardiac surgery. We examine the value of preoperative CRP levels less than 10 mg/l for predicting long-term, all-cause mortality and hospital length of stay in...

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Bibliographic Details
Published in:Anesthesiology (Philadelphia) 2010-03, Vol.112 (3), p.607-613
Main Authors: PERRY, Tjörvi E, MUEHLSCHLEGEL, Jochen D, LIU, Kuang-Yu, FOX, Amanda A, COLLARD, Charles D, BODY, Simon C, SHERNAN, Stanton K
Format: Article
Language:English
Subjects:
Aged
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Biomarkers
C-Reactive Protein - metabolism
Coronary Artery Bypass - mortality
Coronary Artery Bypass - statistics & numerical data
Female
Follow-Up Studies
Humans
Length of Stay
Longitudinal Studies
Male
Medical sciences
Middle Aged
Postoperative Complications - epidemiology
Postoperative Complications - mortality
Predictive Value of Tests
Preoperative Period
Proportional Hazards Models
Prospective Studies
Risk Assessment
Troponin I - blood
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Summary:Preoperative C-reactive protein (CRP) levels more than 10 mg/l have been shown to be associated with increased morbidity and mortality after cardiac surgery. We examine the value of preoperative CRP levels less than 10 mg/l for predicting long-term, all-cause mortality and hospital length of stay in surgical patients undergoing primary, nonemergent coronary artery bypass graft-only surgery. We examined the association between preoperative CRP levels stratified into four categories (< 1, 1-3, 3-10, and > 10 mg/l), and 7-yr all-cause mortality and hospital length of stay in 914 prospectively enrolled primary, nonemergent coronary artery bypass graft-only surgical patients using a proportional hazards regression model. Eighty-seven patients (9.5%) died during a mean follow-up period of 4.8 +/- 1.5 yr. After proportional hazards adjustment, the 3-10 and > 10 mg/l preoperative CRP groups were associated with long-term, all-cause mortality (hazards ratios [95% CI]: 2.50 [1.22-5.16], P = 0.01 and 2.66 [1.21-5.80], P = 0.02, respectively) and extended hospital length of stay (1.32 [1.07-1.63], P < 0.001 and 1.27 [1.02-1.62], P = 0.001, respectively). We demonstrate that preoperative CRP levels as low as 3 mg/l are associated with increased long-term mortality and extended hospital length of stay in relatively lower-acuity patients undergoing primary, nonemergent coronary artery bypass graft-only surgery. These important findings may allow for more objective risk stratification of patients who present for uncomplicated surgical coronary revascularization.
ISSN:0003-3022
1528-1175
DOI:10.1097/aln.0b013e3181cea3b5