术前 C 反应蛋白能否预测体外循环冠状动脉旁路移植术后出血？

Can Preoperative C-Reactive Protein Predict Bleeding After On-Pump Coronary Artery Bypass Grafting?

机构信息

Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Anesthesiology, the First Affiliated Hospital, Nanchang University, Nanchang, China.

出版信息

Ann Thorac Surg. 2020 Feb;109(2):541-546. doi: 10.1016/j.athoracsur.2019.06.059. Epub 2019 Aug 9.

DOI:10.1016/j.athoracsur.2019.06.059

PMID:31404545

Abstract

BACKGROUND

Bleeding after cardiac surgery remains a challenge. Numerous studies suggest that higher level of C-reactive protein (CRP) increases cardiovascular risk. There is limited information revealing the association of preoperative CRP concentration and postoperative bleeding while undergoing on-pump coronary artery bypass grafting (CABG). This study aimed to investigate the relationship between preoperative CRP level and postoperative bleeding within 24 hours after CABG.

METHODS

Data on 1055 patients accepting isolated primary CABG at Fuwai Hospital, Chinese Academy of Medical Sciences from September 2017 to July 2018 were recorded. Preoperative CRP concentration, laboratory coagulation parameters, intraoperative data, and postoperative bleeding volume within 24 hours after surgery were recorded. The primary endpoint was bleeding volume within 24 hours after surgery. We analyzed the correlation between bleeding volume within 24 hours after surgery and preoperative data with univariate and multiple linear regression.

RESULTS

Preoperative CRP concentration (B = -0.094, P < .001), platelet count (B = -0.115, P < .01), thrombocytocrit (B = -0.127, P < .001), prothrombin time (B = 0.052, P < .01), and fibrinogen (B = -0.096, P < .01) were univariably correlated with postoperative bleeding volume. However preoperative CRP concentration (B = -0.089, P < .05) was an independent predictor of postoperative bleeding volume after multiple linear regression. Preoperative CRP concentration was also associated with body mass index (B = 0.068, P = .038), activated partial thromboplastin time (B = 0.089, P < .01), and fibrinogen (B = 0.519, P < .01) after multiple linear regression.

CONCLUSIONS

Our findings suggested that preoperative CRP concentration independently correlated with postoperative bleeding volume within 24 hours and that it could be a new potential coagulation biomarker for patients undergoing CABG surgery.

摘要

背景

心脏手术后出血仍然是一个挑战。许多研究表明，C 反应蛋白（CRP）水平升高会增加心血管风险。虽然有一些研究揭示了在体外循环冠状动脉旁路移植术（CABG）期间，术前 CRP 浓度与术后出血之间的关系，但目前还没有关于术前 CRP 浓度与术后 24 小时内出血的关联的信息。本研究旨在探讨术前 CRP 水平与 CABG 术后 24 小时内出血之间的关系。

方法

记录了 2017 年 9 月至 2018 年 7 月在中国医学科学院阜外医院接受单纯性 CABG 的 1055 例患者的数据。记录了术前 CRP 浓度、实验室凝血参数、术中数据以及术后 24 小时内的出血量。主要终点是术后 24 小时内的出血量。我们使用单因素和多元线性回归分析了术后 24 小时内出血量与术前数据之间的相关性。

结果

术前 CRP 浓度（B = -0.094，P <.001）、血小板计数（B = -0.115，P <.01）、血小板压积（B = -0.127，P <.001）、凝血酶原时间（B = 0.052，P <.01）和纤维蛋白原（B = -0.096，P <.01）与术后出血量呈单变量相关。然而，多元线性回归分析显示，术前 CRP 浓度（B = -0.089，P <.05）是术后出血量的独立预测因子。术前 CRP 浓度与体重指数（B = 0.068，P =.038）、活化部分凝血活酶时间（B = 0.089，P <.01）和纤维蛋白原（B = 0.519，P <.01）也呈多变量相关。