What is the clinical evidence from this study?

Study design: Cohort. Population: Adults undergoing elective cardiac surgery with cardiopulmonary bypass (n=484). Intervention: Dexamethasone vs. No dexamethasone. Primary outcome: Serum CRP concentration measured 12–18 hours after the completion of surgery (postoperative day 1, CRP1).

What does this research mean for the field?

The CRP rs1800947 genotype and perioperative dexamethasone use significantly influence postoperative CRP trajectories, with low-dose dexamethasone proving as effective as high-dose in limiting initial CRP increases after cardiac surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to explore how CRP levels, dexamethasone use, and CRP genotypes are associated with postoperative complications in cardiac surgical patients.

May 26, 2026Open Access

Association between CRP rs1800947 genotypes, dexamethasone use, postoperative CRP level and morbidity in adult cardiac surgical patients in post-hoc analysis of the observational INFLACOR cohort trial

Key Result

In adult cardiac surgical patients, the GC genotype of CRP rs1800947 was associated with a 15% reduction in postoperative day 1 CRP levels, and dexamethasone administration reduced CRP levels by ~30%.

Key Points

This study aims to explore how CRP levels, dexamethasone use, and CRP genotypes are associated with postoperative complications in cardiac surgical patients.
Post-hoc analysis of the INFLACOR cohort trial with 484 adult cardiac surgical patients.
CRP levels evaluated postoperatively, with comparisons based on CRP rs1800947 genotype and dexamethasone doses.
Subgroup analysis of 174 patients with 4-day CRP trajectories.
GC genotype associated with a 15% reduction in postoperative CRP levels on day 1.
Dexamethasone reduced CRP levels by approximately 30%, regardless of dose.
Morning surgeries increased postoperative CRP levels by 27% and elevated preoperative levels increased CRP by 19%.

Study Design

Type

Cohort (n=484)

Blinding

Blinded assessors

Multicenter

Structured PICO

Does dexamethasone use and CRP rs1800947 genotype affect postoperative CRP levels and morbidity in adults undergoing elective cardiac surgery with cardiopulmonary bypass?

Population

484 adults (mean age 65, 55% male) undergoing first-time elective cardiac surgery with cardiopulmonary bypass (CPB). Excluded: history of previous open-chest cardiac surgery, emergency or urgent procedures, off-pump cardiac surgery, and refusal to participate.

Intervention

Intraoperative dexamethasone administered as a single dose at the induction of anaesthesia (low dose median 0.4 mg/kg or high dose median 1.0 mg/kg) and presence of CRP rs1800947 GC genotype.

Comparator

No dexamethasone administration and presence of wild-type CRP rs1800947 GG genotype.

Outcome

Serum CRP concentration measured 12-18 hours after the completion of surgery (postoperative day 1, CRP1).surrogate

Low-dose dexamethasone is as effective as high-dose dexamethasone in limiting postoperative CRP increases, and genetic variants (rs1800947) significantly influence inflammatory responses and potential morbidity risks after cardiac surgery.

Limitations

Potential selection bias due to different sizes of the dexamethasone groups
Selection bias from the study's exclusion criteria
Potential attrition bias in the comparison of combined morbidity between the longitudinal subgroup and the rest of the cohort

Abstract

Abstract Postoperative inflammation contributes to organ dysfunction and complications after cardiac surgery. C-reactive protein (CRP) is a common marker of systemic inflammation. In this study, we assessed how postoperative CRP levels and their trajectories are associated with the CRP rs1800947 gene variant and perioperative dexamethasone use, and how these factors relate to postoperative morbidity. We analysed CRP levels in 484 adults who underwent cardiac surgery with cardiopulmonary bypass (CPB). CRP levels on postoperative day 1 (CRP1) were compared across the rs1800947 genotype and intraoperative dexamethasone dose: (1) none, (2) low (median 0.4 mg/kg), or (3) high (median 1.0 mg/kg). The 4-day CRP trajectories were evaluated in a subgroup of 174 patients with serial CRP measurements. The composite outcome of 30-day morbidity and mortality was analysed to reveal the association with CRP trajectories. Results: Adjusted analysis revealed an association between the GC genotype and a 15% reduction in CRP1 levels. Dexamethasone, regardless of dose, reduced CRP1 levels by ~ 30%. Morning surgery increased CRP1 levels by 27%. Elevated preoperative CRP levels increased postoperative CRP1 levels by 19%. CRP trajectories varied by genotype and dexamethasone exposure. Patients were grouped into four trajectory types, whose associations with postoperative complications differed significantly. Conclusions: Postoperative CRP levels and trends were associated with genetic and clinical factors. Low-dose dexamethasone is as effective as high-dose dexamethasone in limiting increases in CRP1 level. The CRP patterns associated with CRP genotypes and dexamethasone use potentially represent inflammatory endotypes linked to different morbidity risks. Trial registration: This study was registered in the US National Clinical Trial under the code NCT01020409 https://clinicaltrials.gov/ct2/show/study/NCT01020409. Registered on November 24, 2009.

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