A Study On The Relationship Between Inflammatory Response And Coagulation Function In The Perioperative Period Of Cardiovascular Surgery

Part I:Relationship between Perioperative Infection and Thrombosis in Coronary Artery Bypass GraftingObjectives:Surgery related infection remains one of the major complications in patients undergoing cardiac surgery,and their association with thrombosis remains unclear.The purpose of this study was to investigate the association between postoperative infection and thrombosis in patients undergoing coronary artery bypass grafting(CABG).Methods:Perioperative and postoperative follow-up data of all CABG patients in Fuwai Hospital from January 2001 to August 2006 were included.Patients were divided into two groups based on infection,including 75 infected patients and 2,926 control patients.The primary end point was a combination of perioperative thrombosis and long-term thrombotic related complications.Secondary outcomes were MACCEs(including death,myocardial infarction,target revascularization,and stroke)in 5 years postoperatively.Logistic regression analysis and COX survival analysis were used.Results:Risk factors for postoperative infection include age,preoperative creatinine,chronic pulmonary disease,cardiopulmonary bypass time,ascending aorta cross clamp time,history of renal failure,cardiopulmonary bypass,left ventricular assist device or intra-aortic balloon retropulsation,duration of ICU stay,and duration of endotracheal intubation.Postoperative infection resulted in a 5.132-fold increase in perioperative thrombosis compared with the control group(OR,5.132;95%CI:2.040-12.911;p<0.001).Postoperative infection was not associated with MACCEs(HR,1.855;95%HR:0.929-3.704,p=0.080).Age was associated with MACCEs significantly(HR,1.040;95%HR:1.026-1.054);p<0.001).Conclusions:Infection after CABG is associated with perioperative thrombosis.Active control of perioperative infection risk can reduce the incidence of perioperative thrombosis,which provides a basis for clinical work.Part ?:Correlation between Preoperative high-sensitivity C-reactive protein and Postoperative Bleeding after Coronary Artery Bypass GraftingObjectives:Bleeding after cardiac surgery remains a challenge.Numerous studies have shown that elevated high-sensitivity C-reactive protein(hsCRP)levels increase cardiovascular risk.However,the correlation between preoperative hsCRP concentration and postoperative bleeding after coronary artery bypass grafting(CABG)was not investigated.The purpose of this study was to investigate the correlation between preoperative hsCRP level in CABG and postoperative bleeding within 24 h.Methods:A total of 1,055 patients accepting isolate primary CABG treatment in Fuwai Hospital from September 2017 to July 2018 were included in this study.Preoperative hsCRP concentration,laboratory coagulation parameters,intraoperative data and postoperative bleeding volume were recorded.The primary end point was bleeding within 24 hours after surgery.Univariate and multivariate linear regression analysis were used for statistical analysis of preoperative data variables.Results:After univariate linear regression analysis,it was found that preoperative hsCRP concentration(B=-0.094,p<0.001),platelet count(B=-0.115,p<0.01),blood cell count(B=-0.127,p<0.001),prothrombin time(PT)(B=0.052,p<0.01),and fibrinogen(FIB)(B=-0.096,p<0.01)were correlated with postoperative bleeding within 24 hours.However,preoperative hsCRP(B=-0.089,p<0.05)was an independent predictor of postoperative bleeding within 24 hours.Preoperative hsCRP concentration was also correlated with body mass index(BMI)(B=0.068,p=0.038),activated partial thromboplastin time(APTT)(B=0.089,p<0.01),and FIB(B=0.519,p<0.01).Conclusions:Our results suggest that preoperative hsCRP concentration is an independent risk factor for bleeding within 24 hours after CABG and may be a new biomarker of potential coagulation factor in patients undergoing CABG surgery.Part III:Correlation between serum high-sensitivity C-reactive protein and fibrinogen in rhesus monkeysObjectives:Previous studies have shown that high-sensitivity C-reactive protein(hsCRP)is associated with postoperative bleeding in patients with CABG,as well as a correlation with fibrinogen(FIB).The purpose of this study was to investigate the correlation between serum hsCRP and FIB in rhesus monkeys.Methods:Blood samples from 59 rhesus monkeys were collected at the Institute of Molecular Medicine of Peking University.Blood cell routine,biochemical routine and coagulation related indexes were determined.The primary endpoint was fibrinogen level.Univariate and multivariate linear regression analysis was used for statistical analysis.Results:Univariate linear analysis revealed that the factors that predicted FIB included waist circumference(CW)(B=0.019,p=0.003),body mass index(BMI)(B=0.037,p=0.007),and hsCRP(B=1.224,p=0.001).After multivariate linear regression analysis,it was found that hsCRP could independently predict FIB(B=0.063,p=0.018).Conclusions:This study found hsCRP was associated with FIB in rhesus monkeys.Therefore,the correlation between inflammatory response and coagulation system in rhesus monkeys was revealed.