Oc59 Prevalence and Clinical Impact of Systemic Inflammatory Reaction After Cardiac Surgery

Abstract

Background and Aim: The inflammatory reaction associated with cardiac surgery has been widely studied by means of laboratory biomarkers but rarely from a clinical perspective. Many anti-inflammatory treatments have failed to show clinical benefits. In 1992 the ACCP/SCCM conference defined the SIRS (table 1). Our aim is to verify the prevalence of clinically defined SIRS following heart surgery, to identify its predisposing factors and ascertain its impact on early outcome. Methods: We reviewed prospective data of 502 patients who underwent CPB-surgery. According to the mentioned criteria, we defined SIRS in the first day in ICU. We used an automated-matching procedure that for each SIRS-patient selected one without SIRS. A multivariate logistic regression model was used to evaluate the predisposition to develop postoperative-SIRS and its association with a composite outcome (death, TIA/stroke, renal replacement therapy, bleeding, IABP, stay in ICU > 96 hours). Results: 142 patients (28.3%) were SIRS-positive. Propensity-score matched 114 patients. Post-CPB lactates and transfusion-rates were greater in SIRS-patients. Positivity to each SIRS-criteria was associated to the composite outcome for fever (OR2.09; 95%CI1.15–3.80; p = 0.016), heart rate (OR2.08; 95%CI1.23–3.52; p = 0.007), leucocytes (OR1.70; 95%CI0.99–2.91;p = 0.051) adjusting for preoperative creatinine clearance, LVEF and duration of the intervention. Correcting for univariate predictors, the presence of SIRS in the first post-operative day was associated to the composite outcome independently by SIRS preoperative variables. Conclusions: SIRS is a common phenomenon in Cardiac surgery and is frequently associated with some unfavorable clinical outcomes. Therefore, SIRS observed in the first 24 hours after surgery can be a target to improve clinical outcome.

Gaseous micro-embolism (GME) is associated with systemic inflammatory response syndrome (SIRS) after open heart surgery. A missing piece of a complex puzzle?

“…Morbidity and mortality are increased in patients developing SIRS after cardiac surgery [7]. The prevalence of SIRS after cardiac surgery varies according to the criteria defined for its diagnosis and is reported between 12% and 59% [7,8]. In our setting, prevalence was 38%.…”

“…The copyright holder for this preprint this version posted January 23, 2022. ; https://doi.org/10.1101/2022.01.20.22269116 doi: medRxiv preprint varies according to the criteria defined for its diagnosis and is reported between 12% and 59% [7,8]. In our setting, prevalence was 38%.…”

“…Direct contact activation of a non-specific immune reaction following interaction of leucocytes, endothelial cells and foreign surface of the ECC circuit, ischemia-reperfusion injury of the endothelium in general and of specific organs (myocardium, lungs, brain, kidneys) and finally endotoxemia due to splanchnic hypoperfusion and bacterial translocation are suggested as possible causes [8]. In any case the subsequent pathophysiological processes seem to be common to all three mentioned possible causes.…”