C-Reactive Protein as a Diagnostic Tool for Infectious Complications
and Esophagojejunal Anastomotic Leakage after Gastrectomy

Introduction. The tendency to the wide implementation of the enhanced recovery after surgery (ERAS) protocol in the clinical practice leads to the increased requirement in surgical safety that can be provided with the possible earliest detection of postoperative complications and appropriate treatment. This requirement is the most acute in gastric cancer surgery, where despite the improvement of surgical techniques and complex treatment approach the rate of postoperative complications and esophagojejunal anastomotic leakage (EAL) is still high, making up 27% and 10%, respectively. The measurement of C-reactive protein (CRP) concentration in blood plasma is the simplest, most accessible and reliable method to detect infectious complications. However, CRP concentrations, which may indicate the development of postoperative complications, differ significantly in different studies.The aim of the study was to specify the role of CRP as a predictive biomarker for infectious complications and esophagojejunal anastomotic leakage.Materials and methods. This retrospective study included immediate outcomes of the planned radical gastrectomy in 130 patients. The CRP level was assessed depending on the complication type in the immediate postoperative period. Correlation between CRP levels and the incidence of postoperative infectious complications was analyzed. The severity grade of postoperative complications was registered according to the modified Clavien-Dindo classification. The statistical analysis was performed using parametrical and non-parametrical methods. The optimal cut-off CRP for infectious complications and anastomotic leakage was defined with the use of the ROC analysis. The multifactorial ANOVA was performed to detect the effect of contributing factors on the CRP level.Results. An increase in CRP levels over 100 mg/L on the fourth day after surgery can be considered as a manifestation of infectious complications (AUC 0,866 0,042, 95% CI: 0,798-0,934, p 0,001), and an increase in CRP levels over 167 mg/L on the fifth day is a predictor of the development of EAL (AUC 0,869 0,081, 95% CI: 0,711-1,000, p = 0,001). Initial malnutrition and aggravated somatic status appear to be risk factors for the development of infectious complications (p 0,001).Conclusion. Therefore, despite its low specificity, CRP is a sensitive marker of postoperative infectious complications starting from the first days of the postoperative period. Evaluation of the CRP concentration in dynamics allows identifying postoperative complications before the development of clinical manifestations.

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Clinical predictive efficacy of C-reactive protein for diagnosing infectious complications after gastric surgery

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820936542 ◽

2020 ◽

Vol 13 ◽

pp. 175628482093654

Author(s):

Jinyao Shi ◽

Zhouqiao Wu ◽

Qi Wang ◽

Yan Zhang ◽

Fei Shan ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Anastomotic Leakage ◽

Enhanced Recovery ◽

Gastric Surgery ◽

Infectious Complications ◽

C Reactive Protein ◽

Characteristic Analysis ◽

Training Set ◽

Reactive Protein ◽

Validation Set

Background: With the popularization of Enhanced Recovery After Surgery (ERAS), identifying patients with complications before discharging becomes important. This study aimed to explore the efficacy of C-reactive protein (CRP) in predicting infectious complications after gastrectomy. Methods: Patients with gastric cancer who underwent gastrectomy at Beijing Cancer Hospital from March 2017 to April 2018 were enrolled in the training set. Complications were prospectively registered. Receiver operating characteristic analysis was performed to assess the diagnostic accuracy of CRP via evaluating the area under the curve (AUC). Patients who had CRP tested on postoperative day (POD) 5 and accepted gastrectomy from April to December 2018 were included in the validation set to validate the cut-off value of CRP obtained from the training set. Results: A total of 350 patients were included (263 patients in the training set and 87 patients in the validation set). Out of these, 24 patients were diagnosed with infectious complications and 17 patients had anastomotic leakage in the training set. The CRP level on POD5 had superior diagnostic accuracy for infectious complications with an AUC of 0.81. The cut-off value of CRP on POD5 at 166.65 mg/L yielded 93% specificity and 97.2% negative predict value (NPV); For anastomotic leakage, the AUC of CRP on POD5 was 0.81. Using the cut-off value of CRP at 166.65 mg/L on POD5 achieved 92% specificity and 98.6% NPV. The optimal cut-off value (CRP 166.65 mg/L on POD5) was validated in the validation set. It achieved 97.5% specificity and 94.0% NPV for infectious complications, and 97.6% specificity and 96.4% NPV for anastomotic leakage. Conclusion: CRP is a reliable predictive marker for the diagnosis of inflammatory complications following gastric surgery. However, this study was based on preliminary data. The validity of this data needs confirmation by a larger number of cases.

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Diagnostic value of serial measurement of c-reactive protein in serum and matrix metalloproteinase-9 in drainage fluid in the detection of infectious complications and anastomotic leakage in patients with colorectal resection

Vojnosanitetski pregled ◽

10.2298/vsp140723011k ◽

2015 ◽

Vol 72 (10) ◽

pp. 889-898 ◽

Cited By ~ 6

Author(s):

Zoran Kostic ◽

Marina Panisic ◽

Bosko Milev ◽

Zoran Mijuskovic ◽

Damjan Slavkovic ◽

...

Keyword(s):

Matrix Metalloproteinase ◽

Anastomotic Leakage ◽

Colorectal Resection ◽

Infectious Complications ◽

Matrix Metalloproteinase 9 ◽

C Reactive Protein ◽

Drainage Fluid ◽

Serial Measurement ◽

Reactive Protein ◽

Metalloproteinase 9

Background/Aim. Postoperative infectious complications are one of the most important problems in surgical treatment of colorectal cancer (CRC), being present in up to 40% of patients. The aim of this paper was to establish the significance of serial measurement of C-reactive protein (CRP) in serum and matrix metalloproteinase-9 (MMP-9) in drainage fluid for the detection of infectious complications and anastomotic leakage (AL) in patients with colorectal resection. Methods. CRP and MMP-9 values in serum and drainage fluid, respectively, were measured on the first, third, fifth, and seventh postoperative day (POD) in 150 patients with colorectal resection and primary anastomosis. The values obtained were compared between the patients without complications and those with surgical site and remote infections and AL. Results. Surgical site infections (SSIs) were observed in 41 (27.3%), and remote infections in 10 (6.7%) patients. Clinically evident AL was observed in 15 (10%) patients. In 82% of the patients with SSIs, serum CRP value on POD 5 exceeded 82 mg/L, with 81% specificity. AL was reported in 85% and 92% of the patients on PODs 5 and 7, respectively, with CRP values of 77 mg/L and 90 mg/L, respectively. The specificity was 77% for POD 5 and 88% for POD 7. All the patients with CRP values exceeding 139 mg/L on POD 5 had some of SSIs and/or AL. The mean values of MMP-9 were not statistically different between the group without complications (n = 99) and the group with AL (n = 15). Conclusion. Serial measurement of CRP is recommended for screening of infectious complications of colorectal resection. Patients with CRP values above 139 mg/L on POD 5 cannot be discharged from hospital, and require an intensive search for infectious complications, particularly AL. MMP-9 measurement in drainage fluid is not relevant in the detection of AL in patients with colorectal resection.

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The Variation Tendency of Serum C-Reactive Protein is A Good Marker to Exclude Anastomotic Leakage after Laparoscopic Gastrectomy for Adenocarcinoma of Esophagogastric Junction

10.21203/rs.3.rs-35295/v1 ◽

2020 ◽

Author(s):

Bin Luo ◽

Qianchao Liao ◽

Jiabin Zheng ◽

Weixian Hu ◽

Xueqing Yao ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Diagnostic Accuracy ◽

Anastomotic Leakage ◽

Laparoscopic Gastrectomy ◽

Esophagogastric Junction ◽

C Reactive Protein ◽

Reactive Protein ◽

Adenocarcinoma Of Esophagogastric Junction ◽

Variation Tendency

Abstract Backgroud:Esophagojejunal anastomotic leakage (EJAL) after laparoscopic gastrectomy with mediastinal lymph nodes resection for adenocarcinoma of esophagogastric junction (AEG) constituted the most common and serious postoperative complications (PCs). Early diagnosis of EJAL was of great importance. This retrospective study aimed to investigate whether the variation tendency of serum C-reactive protein can be used as an early marker to exclude EJAL after laparoscopic gastrectomy for AEG.Methods:Data for patients underwent laparoscopic gastrectomy for AEG, from January 2015 to March 2020, were retrospectively analyzed. Diagnostic accuracy was determined by the area under the receiver operating characteristic curve. Univariate and multivariate logistic regression analyses were performed to identify risk factors for PCs of grade II or more，according to the Clavien-Dindo classification. Results:A total of 114 patients were analyzed, of whom 21 (18.4%, 95% CI 11.4-25.4 %) developed major PCs, including anastomotic leakage in 13. The ratio of CRP level on postoperative day 3 to day 2 (POD3/2 CRP) provided the best diagnostic accuracy (AUC 0.903, 95% CI 0.814-0.993, p＜0.001). Proximal gastrectomy (OR 8.224, 95% CI 1.976-34.234, p=0.004) and operation time ≥360 minutes (OR 6.753, 95% CI 2.037-22.395, p=0.002) were identified as significant independent risk factors for major postoperative complications.Conclusions:The POD3/2 CRP was the best marker to exclude anastomotic leakage after laparoscopic gastrectomy for AEG.

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C-reactive protein for predicting infectious complications after colorectal surgery within enhanced recovery after surgery: Results from Thailand's largest university hospital

Asian Journal of Surgery ◽

10.1016/j.asjsur.2020.05.027 ◽

2020 ◽

Vol 43 (10) ◽

pp. 1012-1013

Author(s):

Varut Lohsiriwat ◽

Bundhawich Polakla ◽

Sarinda Lertbannaphong

Keyword(s):

Colorectal Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Infectious Complications ◽

University Hospital ◽

C Reactive Protein ◽

Reactive Protein

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DOES ELEVATED 72-HOUR PEAK POST OPERATIVE C-REACTIVE PROTEIN SERUM CONCENTRATION PREDICT POSTOPERATIVE COMPLICATIONS IN MAJOR HEAD AND NECK CANCER OPERATIONS?

10.26226/morressier.578e3b4dd462b80292381e1b ◽

2016 ◽

Author(s):

Sarah Touyz

Keyword(s):

Head And Neck Cancer ◽

Postoperative Complications ◽

Serum Concentration ◽

Head And Neck ◽

Neck Cancer ◽

C Reactive Protein ◽

Reactive Protein ◽

Protein Serum

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Lymphocyte C-reactive protein ratio: A new biomarker to predict early complications after gastrointestinal oncologic surgery

Cancer Biomarkers ◽

10.3233/cbm-210251 ◽

2021 ◽

pp. 1-9

Author(s):

Murat Yildirim ◽

Bulent Koca

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Inflammatory Markers ◽

Operation Time ◽

C Reactive Protein ◽

Oncologic Surgery ◽

Protein Ratio ◽

Colorectal Cancer Surgery ◽

Neutrophil Lymphocyte Ratio ◽

Reactive Protein

BACKGROUND: Lymphocyte-to-C-reactive protein ratio (LCR) has been used as a post-surgical prognostic biomarker in patients with gastric and colorectal cancer. However, its relationship with early postoperative complications in these patients is unknown. In this study, we aimed to reveal the relationship between LCR and postoperative complications. METHODS: Eighty-one patients operated for stomach and colorectal cancer between January 2020 and August 2020 were prospectively analyzed. On preoperative and postoperative days 1, 3 and 5, other inflammatory parameters, mainly LCR, neutrophil lymphocyte ratio (NLR), were recorded. The patients were divided into two groups according to Clavien-Dindo classification as stage III and higher complications major, stage I-II/non-complication minor. RESULTS: Fifty seven patients were operated for colorectal cancer, 24 patients for gastric cancer. The mean age of the patients was 65.6 ± 12.6, 34.6% of them was women. Age, operation time and hospital stay were significantly different between the groups (p= 0.004, p= 0.002, p< 0.001). Major complications developed in 18 patients. On postoperative day 5, LCR found superior diagnostic accuracy in predicting major postoperative complications compared to other inflammatory markers. On the postoperative 5th day, the cut-off value of LCR was 0.0034, 88.8% (71.9–94.8) sensitivity, and 85.7% (73.6–95.4) selectivity. CONCLUSION: Among different inflammatory markers, postoperative LCR is a safe and effective predictor of postoperative complications, especially after gastric and colorectal cancer surgery on day 5.

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