C‐reactive protein in patients undergoing cardiac surgery

Among 25 patients undergoing cardiac surgery with the aid of cardiopulmonary bypass, 13 who recovered uneventfully all had normal (< 2 mg/litre) levels of serum C‐reactive protein pre‐operatively. In contrast, 10 of the 12 patients who suffered from various postoperative complications, including two who died, had abnormally raised levels of C‐reactive protein pre‐operatively. AN patients showed a major acute phase response to surgery with peak C‐reactive protein levels at about 46 hours but, whereas the uncomplicated cases showed a characteristic smooth biphasic pattern of declining levels thereafter, the complicated cases all exhibited significant alterations of this pattern. The occurrence during the postoperative period of a secondary rise in C‐reactive protein or the failure of the level to continue falling, generally preceded clinical evidence of intercurrent infection. Pre‐operative measurement of serum C‐reactive protein may thus make a valuable contribution to the assessment of patients requiring elective cardiac surgery; regular postoperative monitoring can provide early warning of serious complications.