CRP Found to Have Implication for Patients After Undergoing Surgery

C-reactive protein levels predict hospital length of stay and long-term risk of death after surgery.

Boston, MA, March 12, 2010 --( C-reactive protein (CRP), a marker of systemic inflammation routinely measured in patients to assess their risk for heart attack, has recently emerged as a predictor of adverse cardiac events in healthy people. Now researchers at Brigham and Women’s Hospital (BWH) and colleagues have also demonstrated that elevated levels of CRP may increase the length of hospital stay and risk of death for patients who have undergone coronary artery bypass surgery. The findings appear in the March issue of Anesthesiology.

In this new study, research on CRP levels has been extended to the cardiac surgical population; investigating CRP levels as additional predictors for adverse events and increased mortality in otherwise healthy patients undergoing coronary artery bypass surgery.

“Based on previous research, we knew that patients who present for CABG surgery with high levels of circulating CRP are at risk for increased adverse outcomes, including extended hospital stays and elevated mortality rates, compared to patients with normal or very low CRP levels. These risks are increased if high CRP levels are associated with ongoing myocardial ischemia or infarction,” said study author Tjorvi E. Perry, M.D., MMSc an anesthesiologist in the Division of Cardiac Anesthesia at BWH. “What was not known were the implications of slightly to moderately elevated CRP levels in low-acuity patients undergoing routine CABG surgery.”

The researchers studied 914 patients undergoing routine, non-emergency CABG surgery to determine whether circulating preoperative CRP levels in patients could help predict hospital length of stay and long-term postoperative survival.

Patients were stratified to four categories based on preoperative CRP levels; <1mgL, 1-3mgL, 3-10 mg/L and >10 mg/L. Excluding patients with increased CRP levels due to infections, autoimmune disease or ongoing myocardial ischemia or infarction, researchers examined the association between the stratified CRP categories and mortality (death) after CABG surgery.

A total of 87 patients (9.5 percent) died over a mean postoperative follow-up period of 4.8+/-1.5 years. Using a proportional-hazards regression model, results revealed that the 3-10 mg/L CRP group and the >10mg/L CRP group were associated with extended hospital lengths of stay and increased long-term mortality.

"The findings confirm that patients with circulating CRP levels >10 mg/L are at greater risk for adverse events when compared with patients in the lowest preoperative CRP level (< 1mg/L),” said Dr. Perry. “Of great interest is the finding that patients with preoperative levels as low as even 3 mg/L required a longer hospital stay and were at significant risk for increased mortality up to five years after surgery.”

Dr. Perry suggested that his findings indicate not only that CRP levels are an important predictor of adverse outcomes in otherwise low-risk cardiac surgical patients undergoing routine CABG surgery, but also that CRP levels may be a target for perioperative therapeutic intervention to reduce the risk for adverse events after surgery.”

Press release courtesy of the American Society of Anesthesiologists. (

About Brigham and Women's Hospital:-
Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit

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