The association between depressive symptom scores, plasma C-reactive protein levels and postoperative length of stay in patients undergoing coronary artery bypass grafting

Abstract BackgroundThis study aimed to identify the association of preoperative depressive symptoms and C-reactive protein (CRP) levels with postoperative recovery time of patients undergoing coronary artery bypass grafting (CABG). MethodsThe study included 212 elective CABG patients subdivided into two groups based on the presence or absence of preoperative depressive symptoms measured by the Beck Depression Inventory (BDI-II) and the PRIME-MD/PHQ-9 test score. The CRP was measured before surgery, and sequentially (1-6 days postoperatively) during the patient's in-hospital stay. Three summary scores of postoperative CRP response were generated: I) “early” (1-3) II) “persistent” (3-6) and III) “overall” (1-6 postoperative day). ResultsCABG patients with longer postoperative hospital length of stay (LOS > 7 days) have significantly higher total BDI-II (P = 0.014), and CRP measured on days 3 (P = 0.009), 4 (P = 0.001), 5 (P = 0.001), and 6 (P = 0.001) postoperatively, as well as higher “persistent” (P < 0.001) and “overall” (P = 0.004) CRP response. Association of “persistent” and “overall” CRP response to longer postoperative hospital LOS was also confirmed by binary logistic regression analysis. Patients with longer hospital LOS also had lower (P = 0.001) preoperative hemoglobin, a higher EuroSCORE II (P < 0.001), longer ventilation time (P = 0.016), and prolonged intensive care unit length of stay (P = 0.022) when compared to the group with shorter postoperative LOS (< 7 days). Significantly lower preoperative hemoglobin levels (P = 0.044), higher EuroSCORE II (P < 0.001), and longer ventilation time (P = 0.029) was also recorded among patients with elevated depressive symptoms (BDI-II >13). ConclusionsDepressive symptoms are associated with higher operative risk expressed by calculating EuroSCORE II value, longer postoperative hospital LOS, higher preoperative and on the first postoperative day CRP values. There is also a positive correlation with the former and smoking, a slightly lower ejection fraction and significant anemia. A higher CRP on and after the third postoperative day is a positive predictor of an increase in length of postoperative hospital stay. Clinically compromised elderly CABG patients with pronounced comorbidities and female CABG patients were more prone to preoperative depression.