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J Thorac Cardiovasc Surg. 2020 Jan 3. pii: S0022-5223(19)43490-9. doi: 10.1016/j.jtcvs.2019.11.133. [Epub ahead of print]

Preoperative C-reactive protein predicts early postoperative outcomes after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension.

Author information

1
Research and Innovation Unit, INSERM U999, DHU Torino, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France; Department of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford, Calif.
2
Research and Innovation Unit, INSERM U999, DHU Torino, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France; Department of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford, Calif. Electronic address: mamsalle@stanford.edu.
3
Research and Innovation Unit, INSERM U999, DHU Torino, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France; Department of Cardiothoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
4
Department of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford, Calif.
5
Research and Innovation Unit, INSERM U999, DHU Torino, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France.
6
Department of Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France.
7
Department of Pulmonary Diseases, Kremlin Bicetre Hospital‒APHP, Kremlin Bicetre, France.

Abstract

OBJECTIVE:

To determine whether preoperative systemic inflammation (defined by C-reactive protein [CRP] levels ≥10 mg/L) is associated with worse functional and hemodynamic status and poor early outcomes postendarterectomy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

METHODS:

This study included 159 patients who underwent pulmonary endarterectomy from 2009 to 2013 (derivation cohort) and 238 patients from 2015 to 2016 (validation cohort) with CRP data from the national CTEPH registry. The correlations between proinflammatory markers (CRP, interleukins 1 and 6, fibrinogen, and leukocytes) and hemodynamics were assessed in the derivation cohort. Pre-, perioperative characteristics, and 30-day outcomes (ie, death or lung transplant or extracorporeal membrane oxygenation need or inotropic or vasopressor need ≥3 days) of patients with CRP levels ≥ or <10 mg/L were compared.

RESULTS:

Median age of the derivation cohort was 63 [52-73] years with 48% female, 80% in New York Heart Association class III/IV. The validation cohort had similar demographics and disease severity. Patients with CRP ≥10 mg/L had greater resistance levels and lower cardiac index than those with CRP <10 mg/L in both cohorts. The primary endpoint was reached in 38% (derivation) and 42% (validation) of patients. In multivariable logistic regression analysis, CRP ≥10 mg/L was associated with the primary endpoint in both the derivation cohort (odd ratio, 2.49 [1.11-5.61], independently of New York Heart class class IV and aortic clamping duration) and the validation cohort (odd ratio, 1.89 [1.09-3.61], independently of age and aortic clamping duration).

CONCLUSIONS:

Preoperative CRP ≥10 mg/L is independently associated with adverse early outcomes postendarterectomy.

KEYWORDS:

chronic thromboembolic pulmonary hypertension; endarterectomy; inflammation; outcomes; pulmonary hypertension

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