Key result
More severe preoperative depressive symptoms significantly predicted higher postoperative C-reactive protein levels over 10 days (estimate 0.081).
Why the study?
Preoperative depressive and anxiety symptoms and increased postoperative CRP levels are associated with adverse outcomes after cardiac surgery, prompting investigation into whether these psychological symptoms predict elevated postoperative CRP.
Do preoperative depressive and anxiety symptoms predict elevated postoperative C-reactive protein levels in patients undergoing cardiac surgery?
Observational (n=96)
No
Do preoperative depressive and anxiety symptoms predict elevated postoperative C-reactive protein levels in patients undergoing cardiac surgery?
Mean Difference: 0.081 (95% CI 0.023–0.139)
p-value: p=0.007
Preoperative depressive and anxiety symptoms independently predict elevated postoperative CRP levels up to 10 days after cardiac surgery, suggesting an inflammatory mechanism linking psychological distress to adverse surgical outcomes.
Preoperative depressive and anxiety symptoms were associated with higher postoperative CRP; hypothesis-generating for inflammation-mediated outcomes and requires prospective confirmation.
AIM OF THE STUDY: In patients undergoing cardiac surgery, preoperative depressive and anxiety symptoms and increased postoperative C-reactive protein (CRP) levels have been associated with adverse outcomes. We tested the hypothesis that preoperative depressive and anxiety symptoms predict elevated in-hospital CRP levels after cardiac surgery. METHODS: The study participants were 96 consecutive patients (mean age [SD], 67.6 [10.3] years, 78.1% men) from a single cardiac surgery centre who underwent either isolated coronary artery bypass grafting (CABG) (n = 34), isolated valve surgery (n = 29), combined procedures (including different combinations of CABG, valve surgery, aortic surgery, and others) (n = 30), or other cardiac surgical procedures (n = 3). Participants self-rated depressive and anxiety symptoms using the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7) questionnaire before undergoing elective surgery. CRP levels were measured every 24 h up to 10 days post-surgery. Linear mixed (random effects) regression analysis examined the association between preoperative depressive and anxiety symptoms and CRP levels over time, adjusting for pre-surgery CRP levels, demographics, cardiovascular risk factors, medications, and surgery-related variables. RESULTS: Before surgery, 32.2% of patients had clinically relevant depressive symptoms (PHQ-9 score ≥5) and 32.2% of patients had clinically relevant anxiety symptoms (GAD-7 score ≥5). More severe depressive symptoms (estimate [95% CI]: 0.081 [0.023, 0.139], p = 0.007) and more severe anxiety symptoms (0.059 [0.005, 0.113], p = 0.032) predicted CRP levels over 10 days, independent of covariates. Furthermore, CRP levels were higher in patients with than in those without clinically relevant depressive symptoms (0.697 [0.204, 1.191], p = 0.006) and were predicted by both more severe somatic (0.132 [0.035, 0.229], p = 0.008) and cognitive (0.128 [0.014, 0.242], p = 0.029) depressive symptoms. CONCLUSIONS: Preoperative depressive and anxiety symptoms were independent predictors of elevated CRP levels up to 10 days post-surgery. Such a mechanism may help explain the increased morbidity and mortality risk in patients with depression and anxiety who undergo cardiac surgery.
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Känel et al. (2022) conducted an observational in Cardiac surgery (n=96). Preoperative depressive symptoms vs. Lower symptom severity was evaluated on Postoperative C-reactive protein (CRP) levels over 10 days (Estimate 0.081, 95% CI 0.023, 0.139, p=0.007). More severe preoperative depressive symptoms significantly predicted higher postoperative C-reactive protein levels over 10 days (estimate 0.081).
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