Asociación de valores de proteína C reactiva preoperatoria con complicaciones en el posoperatorio de cirugía cardiovascular;
Association between Preoperative C-Reactive Protein Levels with Postoperative Complications of Cardiovascular Surgery

RESUMENIntroducciónEl síndrome de respuesta inflamatoria sistémica es una complicación frecuente en el posoperatorio de cirugía cardíaca, que puede evolucionar con shock vasopléjico y los casos más graves pueden derivar en falla de uno o más órganos. Se describieron predictores en el preoperatorio y el perioperatorio asociados con esta complicación; sin embargo, un estado de inflamación subclínico en la etapa preoperatoria, no detectado por estudios de rutina, podría relacionarse con la respuesta inflamatoria desencadenada en el posoperatorio. Niveles elevados de proteína C reactiva (PCR), un parámetro de inflamación en diferentes escenarios clínicos y que se asocia con el pronóstico de diversas patologías cardiovasculares, podrían predecir el síndrome.ObjetivoEvaluar la contribución de la elevación de los niveles preoperatorios de proteína C reactiva para predecir el síndrome de respuesta inflamatoria sistémica y sus complicaciones posoperatorias en cirugía cardíaca.Material y métodosSe incluyeron 169 pacientes consecutivos, prospectivos (77,3% hombres, edad 61,1 ± 15,9, Euroscore 9,46 [DE 12,7]) sometidos a cirugía cardíaca entre abril de 2007 y diciembre de 2008. Se determinó el nivel de PCR en todos los pacientes. El punto final combinado incluyó síndrome de respuesta inflamatoria sistémica y su asociación con fibrilación auricular, insuficiencia renal, shock o muerte.

BackgroundSystemic inflammatory response syndrome is a frequent postoperative complication of cardiovascular surgery that can develop vasoplegic shock and organ or multiorgan dysfunction in the most severe cases. Preoperative and postoperative predictors associated with this complication have been described; however, a subclinical preoperative inflammatory state, not detected by routine tests, might be related to the postoperative inflammatory response. Elevated C-reactive protein (CRP) levels, a parameter of inflammation in different clinical scenarios that is associated with the prognosis of diverse cardiovascular diseases, might predict the syndrome.ObjectiveTo evaluate the value of elevated C-reactive protein to predict systemic inflammatory response syndrome and its postoperative complications after cardiovascular surgery.Material and MethodsA total of 169 consecutive patients (77.3% were men, age 61.1±15.9, Euroscore 9.46 [SD 12.7]) undergoing cardiovascular surgery were prospectively included between April 2007 and December 2008. CRP levels were determined in all patients. The combined endpoint included the incidence of systemic inflammatory response syndrome and its association with atrial fibrillation, kidney failure, shock or death.ResultsEighty seven patients (54%) developed systemic inflammatory response syndrome and 50 patients (31%) presented the combined endpoint. In-hospital mortality was 5.6% (9 patients).The preoperative levels of CRP ≥2 mg/dl adjusted for preoperative and postoperative variables were independently associated with the combined endpoint (OR 2.95, 95% CI 1.20-7.23; p<0.018), with the development of systemic inflammatory response syndrome (SIRS) (OR 2.46, 95% CI 1.17-5.15; p<0.000), and with the combination of SIRS and kidney failure (OR 5.10, 95% CI 1.48-17.58; p<0.010), SIRS and shock (OR 6.50, 95% CI 1.59-27.34; p<0.005), and SIRS kidney failure (OR 2.91, 95% CI 1.19-7.12; p<0.019) and shock (OR 4.13, 95% CI 1.25-13.60; p < 0.020).ConclusionsPreoperative levels of CRP ≥2.0 mg/dl may predict the systemic inflammatory response syndrome and the systemic inflammatory response syndrome with kidney failure, atrial fibrillation, shock and death in the postoperative period of cardiovascular surgery.