Abstract:According to our results, values of CRP less than 135 mg/l on POD 3 may contribute to a safe discharge from hospital. Patients with CRP values higher than 135 mg/l on POD 3 require prolonged hospitalization and an intensive search for infective complications, particularly AL.
“…17 Moreover, Scepanovic published similar results on 156 patients, getting the best sensitivity and specificity in 3rd POD (73% and 73%, respectively) with a CRP cutoff of 135 mg/L. 18 Singh carried out a meta-analysis about this topic, including 7 studies with a total of 2483 patients, and concluding that CRP is a useful negative predictive test for AL after colorectal surgery. 19 Over the last decade, procalcitonin has emerged as a sensitive and specific biomarker for bacterial infection and became widely used in Intensive Care Units to diagnose and monitor sepsis.…”
PCT and CRP demonstrated to have a good negative predictive value for AL, both in 3rd and in 5th POD. Low levels of PCT, together with low CRP values, seem to be early and reliable markers of AL after colorectal surgery. These biomarkers might be safely added as additional criteria of discharge protocols after colorectal surgery.
“…17 Moreover, Scepanovic published similar results on 156 patients, getting the best sensitivity and specificity in 3rd POD (73% and 73%, respectively) with a CRP cutoff of 135 mg/L. 18 Singh carried out a meta-analysis about this topic, including 7 studies with a total of 2483 patients, and concluding that CRP is a useful negative predictive test for AL after colorectal surgery. 19 Over the last decade, procalcitonin has emerged as a sensitive and specific biomarker for bacterial infection and became widely used in Intensive Care Units to diagnose and monitor sepsis.…”
PCT and CRP demonstrated to have a good negative predictive value for AL, both in 3rd and in 5th POD. Low levels of PCT, together with low CRP values, seem to be early and reliable markers of AL after colorectal surgery. These biomarkers might be safely added as additional criteria of discharge protocols after colorectal surgery.
“…All studies provided information on uninterpretable results except for one study [22]. One study failed to provide information on withdrawals [51]. Fig.…”
PurposeInfectious complications occur frequently after major abdominal surgery and have a major influence on patient outcome and hospital costs. A marker that can rule out postoperative infectious complications (PICs) could aid patient selection for safe and early hospital discharge. C-reactive protein (CRP) is a widely available, fast, and cheap marker that might be of value in detecting PIC. Present meta-analysis evaluates the diagnostic value of CRP to rule out PIC following major abdominal surgery, aiding patient selection for early discharge.MethodsA systematic literature search of Medline, PubMed, and Cochrane was performed identifying all prospective studies evaluating the diagnostic value of CRP after abdominal surgery. Meta-analysis was performed according to the PRISMA statement.ResultsTwenty-two studies were included for qualitative analysis of which 16 studies were eligible for meta-analysis, representing 2215 patients. Most studies analyzed the value of CRP in colorectal surgery (eight studies). The pooled negative predictive value (NPV) improved each day after surgery up to 90 % at postoperative day (POD) 3 for a pooled CRP cutoff of 159 mg/L (range 92–200). Maximum predictive values for PICs were reached on POD 5 for a pooled CRP cutoff of 114 mg/L (range 48–150): a pooled sensitivity of 86 % (95 % confidence interval (CI) 79–91 %), specificity of 86 % (95 % CI 75–92 %), and a positive predictive value of 64 % (95 % CI 49–77 %). The pooled sensitivity and specificity were significantly higher on POD 5 than on other PODs (p < 0.001).ConclusionInfectious complications after major abdominal surgery are very unlikely in patients with a CRP below 159 mg/L on POD 3. This can aid patient selection for safe and early hospital discharge and prevent overuse of imaging.Electronic supplementary materialThe online version of this article (doi:10.1007/s00384-015-2205-y) contains supplementary material, which is available to authorized users.
“…Similarly, C reactive protein may have a role in predicting the need for surgery in patients with abdominal pain,100101 or in identifying post-operative patients who develop a septic complication,102103104105 but the data are insufficient to recommend routine clinical use.…”
Secondary peritonitis accounts for 1% of urgent or emergent hospital admissions and is the second leading cause of sepsis in patients in intensive care units globally. Overall mortality is 6%, but mortality rises to 35% in patients who develop severe sepsis. Despite the dramatic growth in the availability and use of imaging and laboratory tests, the rapid diagnosis and early management of peritonitis remains a challenge for physicians in emergency medicine, surgery, and critical care. In this article, we review the pathophysiology of peritonitis and its potential progression to sepsis, discuss the utility and limitations of the physical examination and laboratory and radiographic tests, and present a paradigm for the management of secondary peritonitis.
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