C-Reactive Protein in Diabetic Patients Before Gastric Bypass as a Possible Marker for Postoperative Complication

Abstract

Background: Obesity and type 2 diabetes mellitus are associated to inflammatory state, which can be set off by the adipose tissue, once it is a metabolically active organ that can cause a chronic mild inflammatory state. Aim: To evaluate the correlation between preoperative C-reactive protein and postoperative complications risk in obese patients (grades II and III) after Roux-en-Y gastric bypass, with and without type 2 diabetes mellitus. Methods : Between 2008 and 2013 were analysed 209 patients (107 with diabetes), presenting body mass index >40 kg/m2or >35 kg/m2with comorbidities. During the postoperative period, two groups were evaluated: with and without complications. Preoperative ultra-sensitive C-reactive protein was measured by immunonephelometry method. Results: Complications occurred in seven patients (pulmonary thromboembolism, fistula, two cases of suture leak, pancreatitis, evisceration and upper digestive hemorrhage). No statistical significance was found regarding lipid profile and C-reactive protein between patients with and without type 2 diabetes mellitus. When compared to each other, both groups (with and without complications) presented with statistical significance regarding C-reactive protein level (7,2 mg/dl vs 3,7 mg/dl, p=0,016) and had similar weight loss percentage after 3, 6 and 12 months follow-up. Conclusions: Preoperative C-reactive protein serum level was higher in the group which presented complications after Roux-en-Y gastric bypass when compared to the group without postoperative complications.

Comparison of the Levels of C-Reactive Protein, GLP-1 and GLP-2 Among Individuals With Diabetes, Morbid Obesity and Healthy Controls: An Exploratory Study

“…Sigalet et al (36) also revealed that pediatric patients with active Crohn's disease presented significantly lower postprandial GLP-2 levels than healthy controls. Although the inflammation is supposed to be much more intense in inflammatory bowel diseases, obesity and T2D are also associated with a low-grade chronic inflammatory state (37)(38)(39)(40) . In fact, the discrepancy in CRP levels among the groups along with the differences in the GLP-2 levels observed in the present study tend to signal that this inflammatory state may also play a significant role in this mechanism.…”

Impact of Bariatric Surgery on the Inflammatory State Based on CPR Value

“…Such increase can be explained, since the rapid weight loss that occurs in the first 30 days promotes necroinflammatory activity in the liver, consequently increasing the CRP values 32 . Lins et al 18 associated high preoperative CRP levels with complications after BGYR.…”

“…Obesity is a chronic disease characterized by excess body fat, which causes injury to the individual 1 . It has grown all over the world, both in developed and underdeveloped countries, with high costs in the treatment of its complications 18 , 27 , 30 . The World Health Organization estimates that each year 2.8 million people die as a result of being overweight or obese 32 .…”

“…The obese patient is constantly associated with a state of chronic inflammation 18 , 27 . Inflammatory cytokines are not only produced in the inflammatory phase of a tissue lesion, but also by adipocytes 9 .…”

“…Ridker et al 24 showed that women with an average of 0.19 mg/dl had a relative risk of atherosclerosis of 2.1. It, greater than 0.3 mg/dl, is accepted as a cut-off for high cardiovascular risk 18 . Low risk is considered lower than 0.1 mg/dl and intermediate risk between 0.1-0.3 mg/dl 19 .…”