Pre-operative CRP elevations in low range predict long-term mortality
MedWire News: Research indicates that even modest pre-operative C-reactive protein (CRP) elevations predict long-term mortality after nonemergent coronary artery bypass graft (CABG) surgery.
“These important findings may allow for more objective risk stratification of patients who present for uncomplicated surgical coronary revascularization,” say Tjörvi Perry (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and colleagues.
Pre-operative CRP levels exceeding 10 mg/l have been linked to morbidity and mortality after cardiac surgery. In the current study, Perry and colleagues categorized 914 patients undergoing nonemergent CABG into four groups based on their pre-operative CRP level: less than 1, 1–3, 3–10, or more than 10 mg/l.
During an average follow-up of 4.8 years, 9.5% of the cohort died. Mortality risk rose with increasing pre-operative CRP level, the team reports in the journal Anesthesiology.
Compared with patients with CRP levels lower than 1 mg/l, those with levels of 1–3, 3–10, and more than 10 mg/l had respective risk increases of 1.43, 2.50, and 2.66 fold, after accounting for demographic and clinical variables, including statin use.
CRP levels also predicted length of hospital stay, with patients who had levels of 3 mg/l or above remaining in hospital for 8 days, compared with 7 days for patients with lower levels.
“Although the clinical relevance of one additional postoperative day in the hospital may be debatable, the costs incurred [are] nonetheless significant,” say Perry et al.
A recent trial showed that statin treatment can reduce patients’ CRP levels, but in the current study statin treatment did not appear to influence survival.
However, the researchers note that the study may have been underpowered to detect a difference, given the small proportion of patients not on statin therapy.
“In light of emerging evidence suggesting beneficial effects on short- and long-term cardiovascular morbidity and mortality in both surgical and nonsurgical cohorts, any inference of discontinuing peri-operative statin therapy should not be made based on our findings,” they caution.
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By MedWire Reporters