Bradley, Nicholas A. and Walter, Amy and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell S.D. and Guthrie, Graeme J.K. and McMillan, Donald C. (2025) The relationship between peri-operative systemic inflammation and survival in patients with abdominal aortic aneurysm. Annals of Vascular Surgery, 110 (Part A). pp. 329-339. ISSN 0890-5096

Abstract

Objective:
An association between pre-operative markers of systemic inflammation and inferior mortality following AAA repair has been observed. The prognostic value of the post-operative inflammatory response remains unreported in patients with AAA. The present study aimed to describe the association between the peri-operative inflammatory response & mortality in patients undergoing endovascular aneurysm repair (EVAR) and open surgical repair (OSR) for infrarenal AAA.

Materials & Methods:
Consecutive patients undergoing either emergency (EVAR or OSR) or elective (OSR) intervention for infrarenal AAA were retrospectively recruited from 3 centres. Pre-operative systemic inflammation was assessed using the modified Glasgow Prognostic Score (mGPS). Post-operative day 3 CRP (≤ 300mg/L, > 300mg/L) was chosen as the covariate of interest. The primary outcome was thirty-day mortality in the emergency cohort and twelve-month mortality in the elective cohort.

Results:
There were 167 emergency cases (120 (72%) OSR) and 207 elective (207 (100%) OSR) cases, with a median (IQR) follow-up of 85 (52) months in the emergency cohort and 63 (57) months in the elective cohort. There were 56% vs. 44% of patients in the emergency cohort day 3 CRP ≤300mg/l vs. >300mg/L compared with 82% vs. 18% of patients in the elective cohort (p < 0.001). On univariate binary logistic regression analyses in the emergency cohort, open repair (p < 0.05), pre-operative mGPS 2 (p < 0.05), post-operative mesenteric ischaemia (p < 0.01), and day 3 post-operative CRP > 300mg/L (p < 0.05) were associated with increased odds of thirty-day mortality. On multivariate binary logistic regression analyses, only pre-operative mGPS 2 (OR 2.11, 95% CI 1.12 – 3.98, p < 0.05) retained independent association with thirty-day mortality. In the elective cohort, mean (95% CI) survival in the day 3 CRP ≤300mg/l vs. >300mg/L was 112.0 (101.8 – 122.2) months vs. 67.2 (54.1 – 80.2) months (p < 0.001). On univariate binary logistic regression analyses in the elective cohort, age ≥ 75 (p < 0.05), ischaemic heart disease (p < 0.05), and day 3 post-operative CRP > 300mg/L (p < 0.001) were associated with increased odds of twelve-month mortality. On multivariate binary logistic regression analyses, both age ≥ 75 (OR 5.15, 95% CI 1.25 – 21.30, p < 0.05) and day 3 post-operative CRP > 300mg/L (OR 15.68, 95% CI 3.61 – 68.15, p < 0.001) retained independent association with twelve-month mortality.

Conclusions:
Pre- and post-operative markers of systemic inflammation were independently associated with inferior survival following emergency and elective repair of AAA respectively. Further investigation of the peri-operative systemic inflammatory response is warranted in this patient group, with a particular focus on identifying targets for intervention.

People
Bradley, N.A.
Author

Bradley, Nicholas A. and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) A systematic review of the role of systemic inflammation-based prognostic scores in patients with abdominal aortic aneurysm. Surgeon, 23 (1). e1-e8. ISSN 1479-666X

Bradley, Nicholas A. and Walter, Amy and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell S.D. and Guthrie, Graeme J.K. and McMillan, Donald C. (2025) The relationship between peri-operative systemic inflammation and survival in patients with abdominal aortic aneurysm. Annals of Vascular Surgery, 110 (Part A). pp. 329-339. ISSN 0890-5096

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

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Walter, Amy
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Bradley, Nicholas A. and Walter, Amy and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell S.D. and Guthrie, Graeme J.K. and McMillan, Donald C. (2025) The relationship between peri-operative systemic inflammation and survival in patients with abdominal aortic aneurysm. Annals of Vascular Surgery, 110 (Part A). pp. 329-339. ISSN 0890-5096

See full publications list
Wilson, Alasdair
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Bradley, Nicholas A. and Walter, Amy and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell S.D. and Guthrie, Graeme J.K. and McMillan, Donald C. (2025) The relationship between peri-operative systemic inflammation and survival in patients with abdominal aortic aneurysm. Annals of Vascular Surgery, 110 (Part A). pp. 329-339. ISSN 0890-5096

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

See full publications list
Siddiqui, Tamim
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Bradley, Nicholas A. and Walter, Amy and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell S.D. and Guthrie, Graeme J.K. and McMillan, Donald C. (2025) The relationship between peri-operative systemic inflammation and survival in patients with abdominal aortic aneurysm. Annals of Vascular Surgery, 110 (Part A). pp. 329-339. ISSN 0890-5096

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

See full publications list
Roxburgh, Campbell S. D.
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Thompson, Joshua J. and MacLeod, Nicholas and Will, Sarah and O'Rourke, Fraser and McGovern, Josh and Roxburgh, Campbell and Edwards, Joanne and Dolan, Ross D. and McMillan, Donald C. (2025) The prognostic value of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin in patients with advanced lung cancer. BMC Cancer, 25: 543. ISSN 1471-2407

Dolan, Ross D. and Pennel, Kathryn and Thompson, Joshua and McKenzie, Molly and Alexander, Peter and Richards, Colin and Black, Douglas and Abbass, Tanvir and Maka, Noori and McGovern, Josh and Roseweir, Antonia and McSorley, Stephen T. and Horgan, Paul G. and Roxburgh, Campbell and McMillan, Donald C. and Edwards, Joanne (2025) The relationship between tumour necrosis, systemic inflammation, body composition and survival in patients with colon cancer. BJC Reports, 3 (1): 7. ISSN 2731-9377

See full publications list
Guthrie, G.J.K.
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Bradley, Nicholas A. and Walter, Amy and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell S.D. and Guthrie, Graeme J.K. and McMillan, Donald C. (2025) The relationship between peri-operative systemic inflammation and survival in patients with abdominal aortic aneurysm. Annals of Vascular Surgery, 110 (Part A). pp. 329-339. ISSN 0890-5096

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

See full publications list
McMillan, D.C.
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Thompson, Joshua J. and MacLeod, Nicholas and Will, Sarah and O'Rourke, Fraser and McGovern, Josh and Roxburgh, Campbell and Edwards, Joanne and Dolan, Ross D. and McMillan, Donald C. (2025) The prognostic value of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin in patients with advanced lung cancer. BMC Cancer, 25: 543. ISSN 1471-2407

Dolan, Ross D. and Pennel, Kathryn and Thompson, Joshua and McKenzie, Molly and Alexander, Peter and Richards, Colin and Black, Douglas and Abbass, Tanvir and Maka, Noori and McGovern, Josh and Roseweir, Antonia and McSorley, Stephen T. and Horgan, Paul G. and Roxburgh, Campbell and McMillan, Donald C. and Edwards, Joanne (2025) The relationship between tumour necrosis, systemic inflammation, body composition and survival in patients with colon cancer. BJC Reports, 3 (1): 7. ISSN 2731-9377

See full publications list
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