INCREASED PREOPERATIVE C-REACTIVE PROTEIN (CRP) VALUES WITHOUT SIGNS OF AN INFECTION AND COMPLICATED COURSE AFTER CARDIOPULMONARY BYPASS (CPB) OPERATIONS

Objective: C-Reactive protein (CRP) is known to be a sensitive indicat or of infection. Since it is also involved in the acute phase reaction , it is of great interest, whether an isolated preoperative increase o f CRP without further signs of infection is of any prognostic value fo r postoperative outcome after cardiac surgery with cardiopulmonary byp ass (CPB), which itself is possibly causing a systemic inflammatory re sponse syndrome (SIRS). Methods: Fifty patients with an isolated CRP-e levation (>5 mg/l) (from 6.2 to 93.3 mg/l) were operated using CPB (gr oup A). A control group (group B) consisted of 50 cardiac surgery pati ents, matched in the patterns of age, gender and kind of disease. No p reoperative CRP-elevation (from 0 to 4.8 mg/l) occurred in this group. Results: The postoperative course of both groups showed significant d ifferences. Septic complications were seen more often in group A (20%) than in the controls (2%) (P < 0.01). Microbiology (blood culture, cu ltures from nose, tracheal aspirate and urine) was positive only in 10 % of these patients. Catecholamine support (epinephrine, norepinephrin e and/or doses of dopamine or dobutamine of more than 3 mu g/kg per mi n) was needed in 26% of group A cases, whereas it was only needed in 1 0% of group B (P < 0.05), A significantly longer respiratory support w as 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 differenc e 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 a pparent infection or inflammation, who had elevated CRP-values preoper atively, face an increased risk of septic complications after extracor poreal circulation. As microbiology tests are negative in most cases, it may be speculated that the majority of septic complications are due to a SLRS. (C) 1998 Elsevier Science B.V. All rights reserved.