D'Agostino Donato, Cappabianca Giangiuseppe, Rotunno Crescenzia, Castellaneta Francesca, Quagliara Teresa, Carrozzo Alessandro, Mastro Florinda, Charitos Ioannis Alexandros, Beghi Cesare
Department of Emergency and Organ Transplantations, Section of Cardiac Surgery, Consorziale Policlinico University Hospital, Bari - University of Bari, Bari, 70124, Italy.
Department of Cardiac Surgery, "Circolo" Hospital, Insubria University, Varese 21100, Italy.
Antibiotics (Basel). 2019 Oct 5;8(4):176. doi: 10.3390/antibiotics8040176.
There are many reasons for the increase in post-operative mortality and morbidity in patients undergoing surgery. In fact, an activated inflammatory state before cardiac surgery, can potentially worsen the patient's prognosis and the effects of this preoperative inflammatory state in the medium-term remains unknown.
There were 470 consecutive patients who underwent cardiac surgery, and were divided in three groups according to the median values of preoperative C-reactive protein (CRP) and fibrinogen (FBG): The first group was the low inflammatory status group (LIS) with 161 patients (CRP < 0.39 mg/dL and FBG < 366 mg/dL); the second was the medium inflammatory status group (MIS) with 150 patients (CRP < 0.39 mg/dL and FBG ≥ 366 mg/dL or CRP ≥ 0.39 mg/dL and FBG < 366 mg/dL,); and the third was the high inflammatory status group (HIS) with 159 patients (CRP ≥ 0.39 mg/dL and FBG ≥ 366 mg/dL,).
The parameters to be considered for the patients before surgery were similar between the three groups except, however, for age, left ventricular ejection fraction (LVEF) and the presence of arterial hypertension. The operative mortality was not significantly different between the groups (LIS = 2.5%, MIS = 6%, HIS = 6.9%, = 0.16) while mortality for sepsis was significantly different (LIS = 0%, MIS = 1.3%, HIS = 3.7%, = 0.03). The infections were more frequent in the HIS group ( = 0.0002). The HIS group resulted in an independent risk factor for infections (relative risk (RR) = 3.1, confidence interval (CI) = 1.2-7.9, = 0.02). During the 48-months follow-up, survival was lower for the HIS patients. This HIS group (RR = 2.39, CI = 1.03-5.53, = 0.05) and LVEF (RR = 0.96, CI = 0.92-0.99, = 0.04) resulted in independent risk factors for mortality during the follow-up.
The patients undergoing cardiac surgery with a preoperative highly activated inflammatory status are at a higher risk of post-operative infections. Furthermore, during the intermediate follow-up, the preoperative highly activated inflammatory status and LVEF resulted in independent risk factors for mortality.
接受手术的患者术后死亡率和发病率增加有多种原因。事实上，心脏手术前的炎症状态激活可能会使患者的预后恶化，而这种术前炎症状态在中期的影响尚不清楚。
连续470例接受心脏手术的患者，根据术前C反应蛋白（CRP）和纤维蛋白原（FBG）的中位数分为三组：第一组为低炎症状态组（LIS），共161例患者（CRP<0.39mg/dL且FBG<366mg/dL）；第二组为中等炎症状态组（MIS），共150例患者（CRP<0.39mg/dL且FBG≥366mg/dL或CRP≥0.39mg/dL且FBG<366mg/dL）；第三组为高炎症状态组（HIS），共159例患者（CRP≥0.39mg/dL且FBG≥366mg/dL）。
三组患者术前需考虑的参数相似，但年龄、左心室射血分数（LVEF）和动脉高血压情况除外。各组手术死亡率无显著差异（LIS = 2.5%，MIS = 6%，HIS = 6.9%，P = 0.16），而败血症死亡率有显著差异（LIS = 0%，MIS = 1.3%，HIS = 3.7%，P = 0.03）。感染在HIS组更为常见（P = 0.0002）。HIS组是感染的独立危险因素（相对危险度（RR）= 3.1，置信区间（CI）= 1.2 - 7.9，P = 0.02）。在48个月的随访期间，HIS组患者的生存率较低。该HIS组（RR = 2.39，CI = 1.03 - 5.53，P = 0.05）和LVEF（RR = 0.96，CI = 0.92 - 0.99，P = 0.04）是随访期间死亡的独立危险因素。
术前炎症状态高度激活的心脏手术患者术后感染风险更高。此外，在中期随访期间，术前炎症状态高度激活和LVEF是死亡的独立危险因素。
