Cardiovascular Journal of Africa: Vol 28 No 6 (November/December 2017)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 1, January/February 2018

AFRICA

may be explained by the different diagnostic criteria, such as

clinical parameters versus the measurement of pro-inflammatory

mediators,

used in the various studies. For instance, Sasse

found a SIRS incidence of 39% in paediatric patients with

a history of prior cardiac surgery, whereas MacCallum

et al

reported that the incidence of SIRS was 96.2% in an adult

cardiothoracic intensive care unit. Our finding that the incidence

of SIRS was 83% in all age groups is consistent with that of

MacCallum

et al

Given the wide range in age of the patients undergoing

CABG, marked differences in postoperative outcomes have

been observed in the different age groups. Several studies have

reported widely varying results, particularly those including

octogenarians. Therefore, although some studies have found

a poor postoperative outcome in older compared to younger

adult patients, others found that CABG was a safe procedure

for octogenarian patients. For example, Sumin

et al

assessed

postoperative outcomes according to age in patients who

underwent CABG. The authors found that the rates of hospital

mortality and postoperative complications were significantly

higher in patients older than 70 years compared to those younger

than 60 years. Similarly, Wilson

et al

reported that the rates

of mortality and postoperative complications were higher in

patients older than 75 years than in younger patients.

In a similar study, Arıtürk

et al

reported that advanced age

was a risk factor for 30-day mortality in patients who underwent

CABG and mitral valve repair as a result of ischaemic mitral

regurgitation. Moreover, an investigation of risk factors

predicting neurological complications following CABG found

that advanced age was a significant risk factor.

Conversely,

several investigators have reported that age had no effect on

postoperative outcomes after CABG. In a study of 8 890

patients, Karimi

et al

found that age was not a predictive factor

for mortality. A meta-analysis of 12 697 older patients found

that the CABG postoperative outcomes were satisfactory.

investigation of arterial graft use for CABG in patients older

than 70 years found that CABG was safe and effective for older

individuals.

We foundno significant differences inmortality or neurological

complication rates among the age groups in our study. Our

finding that the average EuroSCORE value was higher in older

(group 3) than younger (groups 1 and 2) patients is noteworthy

because high EuroSCORE values predict poor early and late

postoperative outcomes.

Aging is associated with increased inflammatory activity;

however, the role of aging on the immune response to various

stimuli is controversial. Krabbe

et al

reviewed studies

investigating the role of gene polymorphisms in inducing

inflammation. Some studies found no association between

age and systemic inflammatory mediators,

21,22

whereas others

reported a marked increase in inflammatory cytokines; in

particular, interleukin-1 (IL1), IL6 and tumour necrosis factor-

alpha (TNF-

) levels were higher in older than in younger

patients.

23,24

We used clinical parameters but not markers of

inflammation to evaluate the effects of age on SIRS. We found

that the incidence of SIRS was significantly higher in patients

older than 75 years than in those younger than 40 years.

Few studies have used clinical parameters to investigate the

correlation between age and SIRS in the postoperative period

after CABG.

Previous investigations of predictive factors for SIRS have

yielded important findings both in terms of identifying and

preventing risk factors; however, it is surprising that so few

studies have investigated the risk factors associated with SIRS

in open-heart surgery, and of those, none have focused on

CABG. A study investigating the correlation between intra-

operative blood transfusion and SIRS found that intra-operative

blood transfusion, low pre-operative functional capacity, liver

dysfunction, chronic obstructive pulmonary disease, male

gender, pre-operative steroid therapy, history of pre-operative

haemodialysis and being older than 74 years were risk factors

for postoperative SIRS.

25,26

An investigation of SIRS in patients

who had undergone transaortic valve implantation found that

the predictive factors for SIRS were contrast amount, major

bleeding, major vascular trauma and blood transfusion.

A study of patients who underwent paediatric heart surgery

found that predictive factors for SIRS were age, low body

weight, and CBP and cross-clamping times.

A similar study in

a paediatric population found that CPB time, low body weight

(

10 kg) and right-to-left shunt were predictive factors for SIRS.

Our findings that age, pre-operative haemoglobin levels,

EuroSCORE value, on-pump CABG and intra-aortic balloon

pump use were predictive factors for SIRS are consistent

with those of previous studies. Our sample size was adequate;

however, a limitation of our study is that pro-inflammatory

mediators were not used to diagnose SIRS.

Conclusion

We found that age was a risk factor for SIRS in patients

undergoing CABG. For this reason, it should be borne in

mind that the risk of developing SIRS in elderly patients

increases, and accordingly, precautionary measures must be

taken. Nevertheless, larger randomised clinical studies in patients

undergoing CABG are needed to clarify the relationship between

age and SIRS.

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