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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2011 June;24(3):125-31
Peak postoperative C-reactive protein levels and long-term mortality in a mixed surgical ICU population: a retrospective, observational-analytical study
Grander W. 1, Luckner G. 2, Torgersen C. 3, Schmittinger C. A. 3, Rex C. 4, Dünser M. W. 3
1 Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Hall in Tirol, Austria
2 Department of Anaesthesiolog and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
3 Department of Intensive Care Medicine, Inselspital, Bern, Switzerland
4 Department of Anesthesiology and Critical Care Medicine, Kreiskliniken Reutlingen, Reutlingen, Germany
AIM: Chronic immune activation is associated with substantial morbidity and mortality. Surgery is a massive non-infectious immune stimulator, as measured by increases in C-reactive protein (CRP) plasma levels. In this retrospective, observational-analytical study, the association between the postoperative peak of plasma CRP levels and long-term mortality in a mixed surgical intensive care unit (ICU) population was investigated.
METHODS:Over 3.5 years, ICU patients admitted within 48 hours after major surgery were analysed. Demographic, clinical and laboratory values, as well as the peak postoperative CRP plasma level were documented. Long-term mortality was collected after a median follow-up time of 5.9 years (IQR, 4.9-6.6 years). A multivariate Cox model was calculated to investigate the association between the postoperative CRP peak and long-term mortality.
RESULTS: Of 1 023 patients included, 355 (34.7%) patients died during the observation period. Non-survivors had a higher postoperative CRP peak than long-term survivors (224 [115-297] vs. 180 [66-263], P<0.001). In the Cox model, maximum CRP plasma levels (mg/L) were not associated with long-term mortality (HR, 1 [0.999-1.001]; P=0.44). While peak postoperative CRP levels (mg/L) were associated with long-term mortality in cardiovascular surgery patients (HR, 1.002 [1-1.004]; P=0.02), no such association was observed in non-cardiovascular surgery patients (HR, 1 [0.999-1.001]; P=0.91).
CONCLUSION: The peak postoperative CRP plasma level response appears not associated with long-term outcome in a mixed surgical ICU population. However, the intensity of the postoperative inflammatory response, as measured by CRP plasma levels, may independently be associated with long-term outcome of critically ill patients undergoing cardiovascular surgery.