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

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.

scholarly journals The variation tendency of serum C-reactive protein is a good marker to predict postoperative complications after laparoscopic gastrectomy for adenocarcinoma of esophagogastric junction

2020 ◽  
Author(s):  
Bin Luo ◽  
Qianchao Liao ◽  
Jiabin Zheng ◽  
Weixian Hu ◽  
Xueqing Yao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Diagnostic Accuracy ◽  
Laparoscopic Gastrectomy ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Adenocarcinoma Of Esophagogastric Junction ◽  
Variation Tendency

Abstract Background: Postoperative complications (PCs) after laparoscopic gastrectomy with mediastinal lymph nodes resection for adenocarcinoma of esophagogastric junction (AEG) prolonged the time of hospitalization and increased mortality rate. Early diagnosis of PCs 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 predict major postoperative complications after laparoscopic gastrectomy for AEG.Methods: Data for patients underwent laparoscopic gastrectomy for AEG, from January 2015 to March 2020, were retrospectively analyzed. The area under the receiver operating characteristic (ROC) curve (AUC) was used to determine diagnostic accuracy of inflammatory markers. The optimal cutoff values were calculated by maximizing Youden’s index. Univariate and multivariate logistic regression analyses were performed to identify risk factors for PCs of grade III 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 PCs.Conclusions: The POD3/2 CRP was the best marker to predict PCs after laparoscopic gastrectomy for AEG.

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

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.

scholarly journals Clinical impact of creatine phosphokinase and c-reactive protein as predictors of postgastrectomy complications in patients with gastric cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Keishi Okubo ◽  
Takaaki Arigami ◽  
Daisuke Matsushita ◽  
Takashi Kijima ◽  
Masataka Shimonosono ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Creatine Phosphokinase ◽  
Early Period ◽  
C Reactive Protein ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
Reactive Protein

Abstract Background Postoperative complications have been linked to the morbidity and mortality of several cancers. However, predicting whether complications will occur in the early period after surgery or not is challenging. Hence, this study aimed to examine the diagnostic accuracy of serum creatine phosphokinase (CPK) and c-reactive protein (CRP) in predicting the development of postgastrectomy complications. Methods We retrospectively analyzed 188 patients with gastric cancer (GC) who underwent gastrectomy. The diagnostic accuracy of serum CPK and CRP was investigated using the areas under the curves (AUC). The CPK ratio was defined as the CPK on postoperative day (POD) 1 to the CPK on a preoperative day. Results Out of 188 patients, 48 (25.5%) developed postoperative complications. The complications group had a greater operative time (p = 0.037), higher CPK ratio on POD1 (p < 0.0001), and a higher serum CRP level on POD3 (p = 0.001). The AUC for the CPK ratio was 0.772, with an optimal cutoff value of 7.05, whereas that for CRP was 0.659, with an optimal cutoff value of 11.4 mg/L. The CPK ratio on POD1 (p < 0.0001) and the CRP on POD3 (p = 0.007) were independent factors for predicting the development of postgastrectomy complications. The CPK ratio on POD1 and the CRP on POD3 predicted postgastrectomy complications in 41 patients (85.4%). According to combined value of both CPK ratio and CRP level, the positive predictive value and the negative predictive value was 0.70 and 0.829. And sensitivity and specificity were 0.438 and 0.936. Conclusion The CPK ratio on POD1 and the CRP on POD3 after gastrectomy for GC were predictive factors for complication development and may be employed to prevent the development of such complications and improve the prognosis of patients with GC.

scholarly journals Predictive value of postoperative C-reactive protein-to-albumin ratio in anastomotic leakage after esophagectomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chi Zhang ◽  
Xiao Kun Li ◽  
Li Wen Hu ◽  
Chao Zheng ◽  
Zhuang Zhuang Cong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Operation Time ◽  
C Reactive Protein ◽  
Roc Curve Analysis ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Potential Risk Factors ◽  
Independent Risk Factors ◽  
The Many

Abstract Introduction Among the many possible postoperative complications, anastomotic leakage (AL) is the most common and serious. Therefore, the purpose of this study was to explore the ability of various inflammatory and nutritional markers to predict postoperative AL in patients after esophagectomy. Methods A total of 273 patients were retrospectively evaluated and enrolled into this study. Perioperative, surgery-related, tumor-related and laboratory tests data were extracted and analyzed. The discriminatory ability and optimal cut-off value was evaluated according to the receiver operating characteristic (ROC) curve analysis. Univariate and multivariate analyses were performed to access the potential risk factors for AL. Results The overall incidence of AL was 12.5% (34/273). C-reactive protein-to-albumin ratio (CRP/ALB ratio) [AUC 0.943 (95% confidence interval (CI) = 0.911–0.976, p <  0.001)] and operation time [AUC 0.747 (95% CI = 0.679–0.815, p <  0.001)] had the greatest discrimination on AL prediction. Multivariate analysis demonstrated that CRP/ALB ratio and operation time were two independent risk factors for AL, and CRP/ALB ratio (OR = 102.909, p <  0.001) had an advantage over operation time (OR = 9.363, p = 0.020; Table 3). Conclusion Operation time and postoperative CRP/ALB ratio were two independent predictive indexes for AL. Postoperative CRP/ALB ratio greater than 3.00 indicated a high risk of AL. For patients with abnormal postoperative CRP/ALB ratio, early non-operative treatment or surgical intervention are needed to reduce the serious sequelae of AL.

scholarly journals Predictive Value of Postoperative C-reactive Protein-to-Albumin Ratio in Anastomotic Leakage after Esophagectomy

2021 ◽  
Author(s):  
Chi Zhang ◽  
XiaoKun Li ◽  
LiWen Hu ◽  
Chao Zheng ◽  
ZhuangZhuang Cong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Operation Time ◽  
C Reactive Protein ◽  
Roc Curve Analysis ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Potential Risk Factors ◽  
Independent Risk Factors ◽  
The Many

Abstract Introduction: Among the many possible postoperative complications, anastomotic leakage (AL) is the most common and serious. Therefore, the purpose of this study was to explore the ability of various inflammatory and nutritional markers to predict postoperative AL in patients after esophagectomy. Methods: A total of 273 patients were retrospectively evaluated and enrolled into this study. Perioperative, surgery-related, tumor-related and laboratory tests data were extracted and analyzed. The discriminatory ability and optimal cut-off value was evaluated according to the receiver operating characteristic (ROC) curve analysis. Univariate and multivariate analyses were performed to access the potential risk factors for AL. Results: The overall incidence of AL was 12.5% (34/273). C-reactive protein-to-albumin ratio (CAR) [AUC 0.943 (95% confidence interval (CI) = 0.911–0.976, p < 0.001)] and operation time [AUC 0.747 (95% CI = 0.679–0.815, p < 0.001)] had the greatest discrimination on AL prediction. Multivariate analysis demonstrated that CAR and operation time were two independent risk factors for AL, and CAR (OR = 87.150, p < 0.001) had an advantage over operation time (OR = 11.178, p = 0.011). Conclusion: Operation time and postoperative CAR were two independent predictive indexes for AL. Postoperative CAR greater than 3.00 indicated a high risk of AL. For patients with abnormal postoperative CAR, early non-operative treatment or surgical intervention are needed to reduce the serious sequelae of AL.

scholarly journals Predictive Value of C-Reactive Protein for Early Postoperative Complications in Children After Hypospadias Surgery

2021 ◽  
Vol 9 ◽  
Author(s):  
Fengming Ji ◽  
Haoyu Tang ◽  
Chengchuang Wu ◽  
Li Chen ◽  
Huake Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Postoperative Complications ◽  
Predictive Value ◽  
Control Group ◽  
C Reactive Protein ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
Reactive Protein ◽  
Urethral Defect

Background: This study explored the predictive value of postoperative C-reactive protein in children with hypospadias for postoperative complications and the risk factors.Methods: The clinical and follow-up data of 106 children with hypospadias who were treated with operations at Kunming Children's Hospital in 2020 were, respectively, analyzed. According to the occurrence of postoperative complications, the patients were divided into two groups: 25 patients with postoperative complications were the complications group, and 81 without postoperative complications were the control group. The baseline data, clinical characteristics, laboratory test indexes, and outcome of the two groups were collected. Receiver operating characteristic (ROC) was used to calculate the optimal cutoff value of C-reaction protein (CRP). Logistic regression was used to analyze the risk factors of hypospadias after surgery. A probability value (P) &lt; 0.05 was considered statistically significant.Results: According to the result of the ROC curve, the optimal cutoff value of CRP was 11.7 mg/L. Logistic regression showed that the length of urethral defect, the urethral material, the operative produce, and the postoperative CRP level were related to the occurrence of postoperative complications of patients with DCC. The length of the urethral defect and the CRP level were the independent risk factors of the prognosis of hypospadias patients. The CRP level was related to the occurrence of postoperative complications and fistula.Conclusions: Postoperative CRP level can be used as a reliable marker for predicting the prognosis of hypospadias patients.

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

2020 ◽  
Vol 13 (3) ◽  
pp. 177-189
Author(s):  
Olga V. Ilina ◽  
Dmitry Valerievich Ruchkin ◽  
Ivan A. Kozyrin ◽  
Yulia A. Stepanova
Keyword(s):  
Postoperative Complications ◽  
Anastomotic Leakage ◽  
Postoperative Period ◽  
Enhanced Recovery ◽  
Surgical Techniques ◽  
Clinical Manifestations ◽  
Infectious Complications ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Esophagojejunal Anastomotic Leakage

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.

scholarly journals Effects of ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition on postoperative complications for patients with Crohn’s disease: a cohort study

2020 ◽  
Author(s):  
Yan Wu ◽  
Huaying Liu ◽  
Weilin Qi ◽  
Wei Liu ◽  
Shasha Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Parenteral Nutrition ◽  
Eligible Patient ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Post Surgery ◽  
Complication Risk

Abstract Background: Most patients with Crohn's disease (CD), a chronic inflammatory disease, need surgery but exhibit elevated postoperative complication incidences. ω-3 polyunsaturated fatty acids (PUFAs) are considered beneficial for nutrition, anti-inflammation, immunity and intestinal microflora balance in humans. This study assessed the effects of ω-3 PUFA-supplemented parenteral nutrition (PN) on postoperative complications in CD.Methods: Overall, 186 CD patients undergoing bowel resection were eligible. Patient data were collected from a prospectively maintained database. After surgery, 103 patients received ω-3 PUFA-supplemented PN; 83 did not. Postoperative complications were compared between the groups. Complication risk factors were identified by univariate and multivariate analyses.Results: Patients with ω-3 PUFA-supplemented PN after surgery had lower C-reactive protein levels (57.2±5.3 mg/L vs 43.5±3.9 mg/L, P=0.047) and shorter postoperative hospital stays (12.1±1.1 days vs 9.3±0.6 days, P=0.041) than those without. The ω-3 PUFA group exhibited significantly reduced incidences of overall complications (40.8% vs 24.1%, P=0.016) and major complications (23.3% vs 9.6%, P=0.014). Postoperative complications were associated with infliximab, ω-3 PUFAs, C-reactive protein, operative time, and laparoscopic surgery. Multivariate regression revealed that preoperative infliximab use and postoperative ω-3 PUFA-supplemented PN were independent risk factors in CD. Conclusions: ω-3 PUFA-supplemented PN reduced post-surgery inflammatory response in CD patients, thus decreasing postoperative complications and accelerating recovery.Trial registration: This trial was registered in ClinicalTrials.gov. Identifier was NCT03901937. The date of registration was 03/04/2019.

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