Perioperative medicine & outcomes
Associations of inflammatory biomarkers with morbidity and mortality after noncardiac surgery: A systematic review and meta-analysis
Pooled result · All-cause mortality, elevated preoperative CRPResult — go to the resultOdds ratio 1.57 95% CI 1.29–1.90Authors' conclusion
Inflammatory biomarker levels in the perioperative period were associated with all-cause mortality and adverse cardiovascular events in patients undergoing noncardiac surgery.
Study context
- Population
- Noncardiac surgery patients with inflammatory biomarkers measured preoperatively and/or within 10 days after surgery
- Participants
- 121,849 patients · 52 studies
- Comparison
- Elevated vs lower perioperative inflammatory biomarker levels
- Outcome
- All-cause mortality and major adverse cardiovascular events
Methodological detailsrandom-effects (DerSimonian-Laird), multivariable adjusted associations, duplicate data extraction, MEDLINE, EMBASE, and CENTRAL searched from inception until May 2023
- Random-effects (DerSimonian-Laird)
- Multivariable adjusted associations
- Duplicate data extraction
- MEDLINE, EMBASE, and CENTRAL searched from inception until May 2023
Pooled result
All-cause mortality, elevated preoperative CRP
Odds ratio
1.57
95% CI 1.29–1.90
Elevated vs lower perioperative inflammatory biomarker levels
OR 1.57 (95% CI 1.29–1.90)
As reported in the abstract
Further pooled results
All-cause mortality by surgery population, elevated preoperative C-reactive protein (CRP) (subgroup)
| OR (95% CI) | ||
|---|---|---|
| Non-cancer surgery populationsI2 = 0%, 4 studies | 2.10 (1.92–2.31) | |
| Cancer surgery populationsI2 = 83%, 24 studies | 1.51 (1.26–1.81) | |
| 0.512Odds ratio (log scale) |
All-cause mortality, higher postoperative CRP
| OR (95% CI) | ||
|---|---|---|
| Higher postoperative CRP levelsI2 = 90%, 7 studies | 1.61 (1.17–2.20) | |
| 0.512Odds ratio (log scale) |
Major cardiovascular events, higher preoperative CRP
| OR (95% CI) | ||
|---|---|---|
| Higher preoperative CRP levelsI2 = 0%, 2 studies | 2.11 (1.51–2.94) | |
| 0.20.5125Odds ratio (log scale) |
All-cause mortality, other preoperative biomarkers
| OR (95% CI) | ||
|---|---|---|
| FibrinogenI2 = 52%, 5 studies | 1.48 (1.05–2.09) | |
| interleukin-6I2 = 27%, 3 studies | 1.17 (1.07–1.28) | |
| Tumour necrosis factor-alphaI2 = 0%, 2 studies | 1.37 (1.16–1.61) | |
| 0.512Odds ratio (log scale) |
- All-cause mortality by surgery population, elevated preoperative CRP (subgroup): p for subgroup difference = 0.001
All-cause mortality by surgery population, elevated preoperative CRP (subgroup)
- Association stronger in non-cancer than cancer surgery populations
Original publication
Associations of inflammatory biomarkers with morbidity and mortality after noncardiac surgery: A systematic review and meta-analysis. J Clin Anesth. Published 2 July 2024. doi:10.
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