Platelet-Activating Factor and Postoperative CRP Predict Unfavorable Outcomes After Major Cardiac Surgery

Background: Multiple markers were investigated to predict adverse outcomes post-cardiac surgery. Platelet-activating factor has a potential involvement in the hematologic and cardiovascular dysfunctions noted during and subsequent to extracorporeal circulation and coronary artery bypass grafting. The objective of our study was to assess Platelet-activating factor and CRP levels and their influence on mortality and morbidity following major heart surgery. Methods: We selected 87 patients that underwent major cardiac surgery between 2021 and 2022 at our institution. We gathered demographical data and unfavorable events after surgery. We investigated a composite outcome comprising three combined outcomes: mortality, renal failure, and stroke, using univariate and multivariate analysis. Results: The study population consisting of 87 individuals with a mean age of 64.9 years old was divided into 4 groups based on CRP levels: normal values (0-10 mg/l), mild increase (10-40 mg/l), moderate increase (40-200mg/l) and severe in-creased (>200 mg/l) levels. There was no significant difference between the 4 CRP groups except higher PAF levels (4939 ±2166.3 pg/ml) and lower baseline LVEF (43.6±6.9%) in group 4 with severely increased CRP values. We also found a significant positive correlation between preoperative PAF levels and post-operative CRP levels (r=0.72, p=0.0001). ROC curve analysis showed that both PAF and CRP can predict post-operative mortality with a good sensitivity and specificity. CRP values > 80 mg/l and PAF values > 5000 pg/ml were associated with combined outcome of: stroke, acute kidney failure and death HR=2.45 (95%CI 0.48-18.3) and HR = 2.62 (95%CI 0.37-20.0) respectively. Conclusions: Preoperative PAF and postoperative CRP are predictors of unfavorable prognosis after major cardiac surgery. C-reactive protein > 80 mg/l and Platelet-activating facotr > 5000 pg/ml were associated with the outcome of: stroke, acute kidney failure and death.