C-Reactive protein kinetics after cardiac surgery: A retrospective multicenter study

Area of Science:

• Biomarkers in Medicine
• Cardiovascular Surgery
• Infectious Disease Diagnostics

Background:

• Postoperative infection detection after cardiac surgery presents diagnostic challenges.
• Existing literature on the utility of biomarkers for early infection recognition is conflicting.
• C-Reactive Protein (CRP) and White Cell Count (WCC) are commonly used inflammatory markers.

Purpose of the Study:

• To evaluate the kinetics of CRP and WCC in the early postoperative period following cardiac surgery.
• To determine if CRP and WCC levels can aid in the early recognition of postoperative infections.
• To assess the influence of cardiopulmonary bypass on CRP and WCC kinetics.

Main Methods:

• Retrospective study including adult cardiac surgery patients without preoperative infections, cirrhosis, or immunosuppression.
• Evaluation of CRP and WCC kinetics during the first postoperative week.
• Comparison of biomarker changes in infected versus non-infected patients and between on-pump and off-pump procedures.

Main Results:

• Postoperative infection occurred in 10.5% of patients (45/429).
• Infected patients exhibited significantly higher CRP from postoperative day 2 and WCC from day 3.
• Both CRP and WCC showed significant within-group changes irrespective of infection status; cardiopulmonary bypass did not affect kinetics.

Conclusions:

• CRP elevation precedes WCC elevation by one day in patients developing postoperative infections, becoming significant on postoperative day 2.
• CRP and WCC kinetics are not influenced by the use of cardiopulmonary bypass in non-infected patients.
• These findings suggest CRP and WCC kinetics can aid in early detection of postoperative infection after cardiac surgery.