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

Mezzomo, Agda; Bodin, Odemir L.; Lúcia, Vera

doi:10.1590/s0066-782x2011005000092

Cited by 9 publications

(4 citation statements)

References 31 publications

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“…In a study conducted by Agda Mezzomo, it was indicated that hsCRP levels higher than 3 mg/dl can be used to predict respiratory infections associated with old age and increased mechanical ventilation (>24 h) and that preoperative hsCRP cannot predict cardiovascular events such as atrial arrhythmias (atrial fibrillation) or death. [12] In a study carried out by Biancari et al ., it was detected that patient candidates for coronary bypass surgery with CPB and preoperative serum concentration of CRP≥1.0 mg/ dl would carry a higher risk of overall, low cardiac output syndrome, and postoperative cardiac death. [13] Preoperative serum concentration of CRP≥1.0 mg/dL was significantly more frequent among patients with a history of myocardial infarction and low left ventricular ejection fraction in patients undergoing surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative C-reactive protein can predict early clinical outcomes following elective off-pump CABG surgery in patients with severe left ventricle dysfunction

et al. 2012

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Purpose:Atrial fibrillation (AF) is the most common type of arrhythmia following elective off-pump coronary bypass graft (CABG) surgery, occurring on the 2nd or 3rd postoperative day. Postoperative atrial fibrillation and early complications may be the cause of long term morbidity and mortality after hospital discharge. High sensitive C-reactive protein (hsCRP) seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate whether preoperative hsCRP (≥3 mg/dl) can predict post-elective off-pump CABG, AF, and early complications in patients with severe left ventricle dysfunction (Ejection Fraction (EF)<30%).Methods:This study was conducted on 104 patients with severe left ventriclar dysfunction (EF < 30%), undergoing elective off-pump CABG surgery during April to September 2011 at the Afshar Cardiovascular Center in Yazd, Iran. Patients undergoing emergency surgery and those with unstable angina, creatinine higher than 2.0 mg/dl, malignancy, or immunosuppressive disease were excluded from the study. The subjects were divided into two groups: Group I with preoperative increased hsCRP (>3 mg/dl) (n=51) and group N with preoperative normal hsCRP (<3 mg/dl) (n=53). We evaluated post-CABG variables including incidence, duration, and frequency of AF, early morbidity (bleeding, infection, vomiting, renal and respiratory dysfunctions), ICU or hospital stay and early mortality. Data were then analyzed by Analysis of Variance (ANOVA), Chi-square and Fisher exact test for quantitative and qualitative variables.Results:The average age of the patients was 62.5 years, 75 cases (72.1%) were male, and 39 (37.5%) were female. Postoperative AF occurred in 19 cases (18.2%); 17 cases (33.3%) had hsCRP≥3 mg/dl and 2 cases (3.8%) had hsCRP≤3 mg/dl (P=0.03). Postoperative midsternotomy infection, respiratory dysfunction, and hospital stay were significantly higher in group I compared with group N (P<0.05). No statistical significant differences were identified between the two groups concerning other postoperative complications (bleeding, vomiting, renal dysfunction and ICU stay) (P>0.05).Conclusion:Preoperative hsCRP ≥3 mg/dl can predict incidence of postoperative atrial fibrillation and early complications such as midsternotomy infection, respiratory dysfunction, and hospital stay following elective off-pump CABG.

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Section: Discussionmentioning

confidence: 99%

Preoperative C-reactive protein can predict early clinical outcomes following elective off-pump CABG surgery in patients with severe left ventricle dysfunction

et al. 2012

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“…CRP levels in that study were unrelated to pneumonia risk, though the CRP assay used in that study was not a newer high-sensitivity assay such as the one we used, so their CRP data may have been compromised to some degree. Two other studies of patients undergoing cardiac surgery also showed that elevated preoperative CRP levels were associated with increased postoperative respiratory infection risk [27], [28].…”

Section: Discussionmentioning

confidence: 94%

Biomarkers and Bacterial Pneumonia Risk in Patients with Treated HIV Infection: A Case-Control Study

et al. 2013

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BackgroundDespite advances in HIV treatment, bacterial pneumonia continues to cause considerable morbidity and mortality in patients with HIV infection. Studies of biomarker associations with bacterial pneumonia risk in treated HIV-infected patients do not currently exist.MethodsWe performed a nested, matched, case-control study among participants randomized to continuous combination antiretroviral therapy (cART) in the Strategies for Management of Antiretroviral Therapy trial. Patients who developed bacterial pneumonia (cases) and patients without bacterial pneumonia (controls) were matched 1∶1 on clinical center, smoking status, age, and baseline cART use. Baseline levels of Club Cell Secretory Protein 16 (CC16), Surfactant Protein D (SP-D), C-reactive protein (hsCRP), interleukin-6 (IL-6), and d-dimer were compared between cases and controls.ResultsCases (n = 72) and controls (n = 72) were 25.7% female, 51.4% black, 65.3% current smokers, 9.7% diabetic, 36.1% co-infected with Hepatitis B/C, and 75.0% were on cART at baseline. Median (IQR) age was 45 (41, 51) years with CD4+ count of 553 (436, 690) cells/mm3. Baseline CC16 and SP-D were similar between cases and controls, but hsCRP was significantly higher in cases than controls (2.94 µg/mL in cases vs. 1.93 µg/mL in controls; p = 0.02). IL-6 and d-dimer levels were also higher in cases compared to controls, though differences were not statistically significant (p-value 0.06 and 0.10, respectively).ConclusionsIn patients with cART-treated HIV infection, higher levels of systemic inflammatory markers were associated with increased bacterial pneumonia risk, while two pulmonary-specific inflammatory biomarkers, CC16 and SP-D, were not associated with bacterial pneumonia risk.

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“…However, specificity of this risk model seems to be poor and prevents implementation of preventive strategies. Another cohort study from Brazil in 331 patients with a rate of 16% for postoperative pneumonia comes to the conclusion that preoperative level of highly sensitive C-reactive protein (CRP) >3 mg/l is an independent predictor for postoperative respiratory infection [28]. However, specificity is also problematic with this approach, as CRP is not only increased in pulmonary infections, but also in a variety of comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Dysfunction of alveolar macrophages after 3 cardiac surgery and postoperative pneumonia? – an 5 observational study

et al. 2013

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IntroductionPatients undergoing cardiac surgery have an increased risk of postoperative pneumonia. Pulmonary immune dysfunction might be a contributing factor. We therefore determined changes of the surface molecules on alveolar macrophages (AMs). To characterize modulation in patients with pneumonia we correlated these changes to the development of postoperative pneumonia.MethodsAfter ethical approval and written informed consent, 33 patients undergoing elective coronary bypass grafting surgery were included in this observational study. Peripheral blood cells and alveolar lavage fluid were collected directly after induction of anesthesia and two hours after separation from cardiopulmonary bypass (CPB). Human leukocyte antigen-DR (HLA-DR) and toll-like receptors (TLR) 2/4 expression on monocytes and AM were assessed by flow cytometry. A total of three patients developed postoperative pneumonia determined according to the criteria of the Center of Disease Control. Statistical analysis was performed with the Mann–Whitney-U test and Wilcoxon test.ResultsWe found significant changes of phenotypic and functional immune markers on AMs after cardiac surgery. HLA-DR expression on peripheral blood monocytes and AMs was significantly reduced compared to baseline in all patients (each approximately 30%). After surgery patients who developed postoperative pneumonia revealed a trend of stronger reduction of HLA-DR expression (83.7% versus 27.1%) and TLR4 expression on AMs (46.1% versus 9.9%) compared to patients without pneumonia. Already before surgery, the baseline of TLR2 expression on AM was significantly lower (27.7%) in patients who developed postoperative pneumonia.ConclusionsAs far as we know this is the first study that shows an early impairment of lung cellular immune response after cardiac surgery. These findings can help to understand the role of cell-mediated immunosuppression and its association to the development of postoperative pneumonia.

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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.

Cited by 9 publications

References 31 publications

Preoperative C-reactive protein can predict early clinical outcomes following elective off-pump CABG surgery in patients with severe left ventricle dysfunction

Preoperative C-reactive protein can predict early clinical outcomes following elective off-pump CABG surgery in patients with severe left ventricle dysfunction

Biomarkers and Bacterial Pneumonia Risk in Patients with Treated HIV Infection: A Case-Control Study

Dysfunction of alveolar macrophages after 3 cardiac surgery and postoperative pneumonia? – an 5 observational study

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