Diagnostic accuracy of C-reactive protein and procalcitonin in the early detection of infection after elective colorectal surgery – a pilot study

Abstract Background: Infectious complications remain a major clinical problem in colorectal surgery, contributing to prolonged hospital stays, additional costs and significant postoperative mortality. Presepsin has been reported to be a useful marker to diagnose sepsis, similar or superior to procalcitonin (PCT) and C-reactive protein (CRP), and plasma presepsin concentrations are associated with the severity of sepsis and its outcome. The aim of this study was to assess the diagnostic value of presepsin in the early detection of infectious complications after elective colorectal surgery, compared with CRP and PCT.Methods: This study was a prospective observational study. Patients of age >18 who underwent elective colon resections were enrolled and patients with end-stage kidney disease were excluded. Blood samples were collected just before surgery and on postoperative day (POD) 1, 2, 3, 4, and 6. Infectious complications were diagnosed by surgeons. Results: A total of 114 patients were examined, and 27 patients (23.7%) developed infectious complications: 11 anastomotic leaks, 13 intra-abdominal infections, and 3 wound infections. CRP and PCT markedly increased from POD1 to POD3 and then gradually decreased toward POD6 in both groups, but the trends of the decrease in the infected group were blunt, compared with those in the non-infected group. On the other hand, presepsin did not show major changes just after surgery, but it increased on POD4 and POD6, when the complications occurred. ROC analysis to predict infectious complications revealed that the best accuracy was obtained on POD 6 for all biomarkers. CRP showed excellent predictability and presepsin showed good predictability. However, the cut-off values of all biomarkers were relatively lower than expected. Conclusions: The trends of change in presepsin following colorectal surgeries were distinct from those of CRP and PCT. Monitoring the presepsin trends after colorectal surgeries could be helpful to detect postoperative infectious complications.Trial registration: UMIN000025313. Registered on 17 December 2016.

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Diagnostic Accuracy of Procalcitonin and C-reactive Protein for the Early Diagnosis of Intra-abdominal Infection After Elective Colorectal Surgery

Annals of Surgery ◽

10.1097/sla.0000000000001545 ◽

2016 ◽

Vol 264 (2) ◽

pp. 252-256 ◽

Cited By ~ 33

Author(s):

François Cousin ◽

Pablo Ortega-Deballon ◽

Abderrahmane Bourredjem ◽

Alexandre Doussot ◽

Valentina Giaccaglia ◽

...

Keyword(s):

Colorectal Surgery ◽

Early Diagnosis ◽

Diagnostic Accuracy ◽

C Reactive Protein ◽

Elective Colorectal Surgery ◽

Abdominal Infection ◽

Reactive Protein ◽

Intra Abdominal Infection

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C-reactive protein on postoperative day 3 as a predictor of infectious complications following gastric cancer resection.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.26 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 26-26

Author(s):

Kazumasa Fujitani ◽

Yuji Shishido ◽

Kazuyoshi Yamamoto ◽

Motohiro Hirao ◽

Toshimasa Tsujinaka ◽

...

Keyword(s):

Gastric Cancer ◽

Early Detection ◽

Diagnostic Accuracy ◽

Predictive Factors ◽

Infectious Complications ◽

C Reactive Protein ◽

Cancer Resection ◽

Reactive Protein ◽

Gastric Cancer Resection ◽

Grade Iii

26 Background: Postoperative infectious complications (PICs) after gastric cancer resection remain a clinically relevant problem. Early detection of PICs, before critical illness develops, may be of considerable clinical benefit. The aims of this study were to investigate the predictive factors for PICs and to define the clinical parameters for their early detection in patients with gastric cancer resection. Methods: Clinical data of 417 consecutive patients undergoing elective gastrectomy for primary gastric cancer between 2009 and 2012 were retrospectively analyzed. Diagnostic accuracy was determined by the area under the receiver operating characteristic curve (AUC). Univariate and multivariate logistic regression analyses identified clinical factors predicting PICs of grade III or more according to the Clavien-Dindo classification. Results: Forty-four patients developed PICs of grade ≥ III (10.6%, 95% confidence interval [CI] 7.6–13.5%). As a systemic inflammatory marker, C-reactive protein (CRP) on postoperative day (POD) 3 had superior diagnostic accuracy for PICs (AUC 0.802, 95% CI 0.735–0.870) with a calculated cut-off value of 17.7 mg/dl, yielding a sensitivity of 0.66 (95% CI 0.524–0.774) and a specificity of 0.84 (95% CI 0.821–0.850). Multivariate analysis identified CRP on POD 3 of 17.7 mg/dl or greater (odds ratio [OR] 8.094, 95% CI 3.568–19.342) as well as clinical stage ≥ II (OR 4.445, 95% CI 1.478–15.881) and operation time ≥ 250 min (OR 3.638, 95% CI 1.449–10.137) as significant predictive factors for PICs after gastrectomy. Conclusions: Elevated CRP levels on POD 3 will help physicians predict postoperative course and facilitate decision-making regarding the prompt, comprehensive clinical search and therapeutic approach for PICs.

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Elevated preoperative C-reactive protein levels are a risk factor for the development of postoperative infectious complications following elective colorectal surgery

Langenbeck s Archives of Surgery ◽

10.1007/s00423-013-1107-0 ◽

2013 ◽

Vol 398 (7) ◽

pp. 965-971 ◽

Cited By ~ 9

Author(s):

Toru Kubo ◽

Satoshi Ono ◽

Hideki Ueno ◽

Eiji Shinto ◽

Junji Yamamoto ◽

...

Keyword(s):

Risk Factor ◽

Colorectal Surgery ◽

Infectious Complications ◽

C Reactive Protein ◽

Elective Colorectal Surgery ◽

Protein Levels ◽

Reactive Protein

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Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

10.21203/rs.3.rs-96106/v2 ◽

2021 ◽

Author(s):

Sufana Alsaif ◽

Ailín C Rogers ◽

Priscilla Pua ◽

Paul T Casey ◽

Geoff G Aherne ◽

...

Keyword(s):

Postoperative Complications ◽

Colorectal Surgery ◽

Inflammatory Markers ◽

Postoperative Morbidity ◽

Colorectal Neoplasia ◽

Full Blood Count ◽

C Reactive Protein ◽

Elective Colorectal Surgery ◽

Reactive Protein ◽

Grade 3

Abstract Background: Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim: The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods: This retrospective study catalogues 218 patients undergoing elective, potentially-curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results: Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6 and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC=0.871), and values above 17.5 mg/L predicted severe complications (AUC=0.934). Conclusions: Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

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Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery

Croatian Medical Journal ◽

10.3325/cmj.2012.53.612 ◽

2012 ◽

Vol 53 (6) ◽

pp. 612-619 ◽

Cited By ~ 50

Author(s):

Dagmar Oberhofer ◽

Josip Juras ◽

Ana Marija Pavičić ◽

Iva Rančić Žurić ◽

Vlatko Rumenjak

Keyword(s):

Colorectal Surgery ◽

Infectious Complications ◽

C Reactive Protein ◽

Elective Colorectal Surgery ◽

Reactive Protein

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Preoperative C-reactive protein and other inflammatory markers as predictors of postoperative complications in patients with colorectal neoplasia

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02142-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Sufana H. Alsaif ◽

Ailín C. Rogers ◽

Priscilla Pua ◽

Paul T. Casey ◽

Geoff G. Aherne ◽

...

Keyword(s):

Postoperative Complications ◽

Colorectal Surgery ◽

Inflammatory Markers ◽

Postoperative Morbidity ◽

Colorectal Neoplasia ◽

Full Blood Count ◽

C Reactive Protein ◽

Elective Colorectal Surgery ◽

Reactive Protein ◽

Grade 3

Abstract Background Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods This is a retrospective study which catalogs 218 patients undergoing elective, potentially curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6, and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC = 0.871), and values above 17.5 mg/L predicted severe complications (AUC = 0.934). Conclusions Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

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