Proteína C Reativa pré-operatória prediz infecção respiratória após cirurgia de revascularização miocárdica

Abstract

BACKGROUND: Increased levels of high-sensitive C-reactive protein (hsCRP) in the preoperative evaluation for coronary artery bypass graft surgery (CABG) have been associated to poor outcomes in the postoperative period. OBJECTIVE: To evaluate the association of high levels of hsCRP with short-term outcomes after cardiac surgery. METHODS: Prospective cohort with 331 patients who underwent CABG surgery with cardiopulmonary bypass (CPB) at our Institution. Patients were assigned to two groups according to hsCRP levels, measured before surgery: normal (N group) with <3 mg/l hsCRP; and increased (A group) with >3 mg/l hsCRP. This cutoff of 3 mg/l had a sensitivity and specificity of 60 percent for predicting respiratory infection, with a power of 90 percent. The patients were followed-up during the in-hospital period. RESULTS: The mean age was 60 years, and 71.6 percent of the patients were male. HsCRP was increased (group A) in 144 patients (43.5 percent). In-hospital mortality was 4.8 percent and the most frequent complications in both groups were: overall infections (18 percent), respiratory infections (16 percent), atrial fibrillation (15 percent) and acute myocardial infarction (7.6 percent). The incidence of postoperative overall infections was 14.4 percent in the N group and 23.6 percent in the A group (P=0.046). Respiratory infections were also more frequent in the A group (21.5 percent vs. 11.8 percent; p = 0.024). Multivariate analyses showed that hsCRP level represented an independent predictor of postoperative respiratory infection (OR=2.08, 95 percent IC = 1.14-3.79). CONCLUSION: High preoperative hsCRP level is an independent predictor of respiratory infections in the mid-term postoperative period of elective coronary artery bypass graft surgery.