A meta‐analysis of the utility of C‐reactive protein in predicting early, intermediate‐term and long term mortality and major adverse cardiac events in vascular surgical patients

Abstract

SummaryWe conducted a meta-analysis of the utility of pre-operative C reactive protein (CRP) in predicting early (< 30 days), intermediate (30-180 days) and long term (> 180 days) mortality and major adverse cardiac events (MACE; cardiac mortality and nonfatal myocardial infarction (MI) combined) following vascular surgery. Of 291 studies identified, ten prospective patient cohorts were identified. A pre-operative CRP > 3 mg. Vascular surgery is associated with major adverse perioperative cardiac events. Unfortunately, currently used pre-operative diagnostic tests for these patients are not statistically robust enough to accurately predict these events [1]. A meta-analysis of six pre-operative tests for vascular surgical patients which included; ambulatory ECG, exercise ECG, radionuclide ventriculography, myocardial perfusion scintigraphy, dipyridamole stress echocardiography and dobutamine stress echocardiography, showed that dobutamine stress echocardiography had a trend to the best performance of the six tests for the prediction of major adverse cardiac events (MACE; defined as peri-operative cardiac death and non-fatal myocardial infarction (MI) within 30 days of surgery [2]), with a positive likelihood ratio (LR) and negative LR of 2.8 and 0.21 respectively. As statistically, good discrimination requires a LR of > 10 and < 0.2, there are clearly clinical limitations to the utility of these pre-operative tests for vascular surgical patients [1].

Neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio as predictors of survival after heart transplantation

“…Before surgery, several inflammatory markers haven shown prognostic value in HF including tumour necrosis factor and its receptors, the interleukin (IL)‐1 and IL‐6 families, galectin‐3, and C‐reactive protein 3, 4. Besides, increased inflammation before cardiac surgery with cardiopulmonary bypass is associated with worse outcome 5, 6. After surgery, graft inflammation may respond to several mechanisms, from alloantigen‐directed immune reactions of the recipient resulting in graft rejection to ischaemia/reperfusion injury of the graft 7.…”

“…3,4 Besides, increased inflammation before cardiac surgery with cardiopulmonary bypass is associated with worse outcome. 5,6 After surgery, graft inflammation may respond to several mechanisms, from alloantigen-directed immune reactions of the recipient resulting in graft rejection to ischaemia/reperfusion injury of the graft. 7 Inflammation of the donor before explantation is also associated with worse outcome of the recipient.…”

Weight loss in elderly women in low-level care and its association with transfer to high-level care and mortality

“…However, C-reactive protein levels were higher in those who lost weight. High C-reactive protein, as a positive acute phase reactant suggests a proinflammatory state 27. Although not specifically examined here, C-reactive protein and other biomarkers of inflammation may well have utility in signaling the potential for more adverse health outcomes in elderly women.…”

Silicon Nanosensor for Diagnosis of Cardiovascular Proteomic Markers

“…1 C-reactive protein (CRP) and NT-pro-brain natriuretic peptide (BNP) have been associated with increased mortality after vascular surgery. [2][3][4][5][6][7] Several large-scale population studies have demonstrated that CRP profiling has improved the prediction of the first cardiovascular event. [8][9][10] The use of proteomic tools to create molecular signatures of disease is a recent development in the domain of disease diagnostics.…”