Preoperative depression and anxiety as predictors of postoperative C-reactive protein levels in patients undergoing cardiac surgery: a prospective observational study

Abstract

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.

Psychological Outcomes and Quality of Life After Hysterectomy for Benign Diseases: A Prospective Cohort Study

“…The high frequency of psychological disorders before surgery can be explained by the intensity of the preoperative symptoms, which, in some cases, can significantly impact daily functioning. Mood disorders are known to precede various surgical interventions, including hysterectomy [ 16 , 17 ]. Specifically, patients often express concerns about the possibility of pelvic neoplasia and attribute their preoperative symptoms to this potential risk.…”

A comparative analysis of open heart surgery and minimally invasive cardiac surgery in exercise-based cardiac rehabilitation

“…Since anxiety and depression are common among EBCR patients and significantly impact QoL and future cardiac events [ 20 – 22 ], another vital pillar of treatment during EBCR is psychological evaluation and support [ 7 ]. In fact, in addition to data from Cochrane reviews, two studies in which EBCR was supplemented by psychotherapy have recently been shown to reduce the HADS scores, improve QoL and adherence to EBCR, and reduced cardiovascular readmissions [ 9 , 23 , 24 ].…”