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Eur J Cardiothorac Surg 1998;13:541-545
© 1998 Elsevier Science NL

Increased preoperative C-reactive protein (CRP)-values without signs of an infection and complicated course after cardiopulmonary bypass (CPB) – operations¹

Department of Thoracic and Cardiovascular Surgery, Heinrich Heine University Hospital, Heinrich Heine Universität Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany

Received 29 September 1997; received in revised form 16 February 1998; accepted 24 February 1998.

Corresponding author. Tel.:+49 211 8118331; fax:+49 211 8118333.

Objective: C-Reactive protein (CRP) is known to be a sensitive indicator of infection. Since it is also involved in the acute phase reaction, it is of great interest, whether an isolated preoperative increase of CRP without further signs of infection is of any prognostic value for postoperative outcome after cardiac surgery with cardiopulmonary bypass (CPB), which itself is possibly causing a systemic inflammatory response syndrome (SIRS). Methods: Fifty patients with an isolated CRP-elevation (>5 mg/l) (from 6.2 to 93.3 mg/l) were operated using CPB (group A). A control group (group B) consisted of 50 cardiac surgery patients, matched in the patterns of age, gender and kind of disease. No preoperative CRP-elevation (from 0 to 4.8 mg/l) occurred in this group. Results: The postoperative course of both groups showed significant differences. Septic complications were seen more often in group A (20%) than in the controls (2%) (P<0.01). Microbiology (blood culture, cultures from nose, tracheal aspirate and urine) was positive only in 10% of these patients. Catecholamine support (epinephrine, norepinephrine and/or doses of dopamine or dobutamine of more than 3 µg/kg per min) was needed in 26% of group A cases, whereas it was only needed in 10% of group B (P<0.05). A significantly longer respiratory support was also necessary in patients with elevated CRP (25.2±6.4 h vs. 6.6±0.8 h) (P<0.01). Furthermore there was a significant difference in the duration of intensive care (4.6±0.8 days vs. 2.6±0.3 days) (P<0.05). Conclusions: These data show that patients without apparent infection or inflammation, who had elevated CRP-values preoperatively, face an increased risk of septic complications after extracorporeal circulation. As microbiology tests are negative in most cases, it may be speculated that the majority of septic complications are due to a SIRS.

Key Words: C-Reactive protein • Postoperative complications • Systemic inflammatory response syndrome • Sepsis • Cardiopulmonary bypass

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