Diagnostic Accuracy of Inflammatory Markers As Early Predictors of Infection After Elective Colorectal Surgery

Facy, Olivier; Paquette, Brice; Orry, David; Binquet, Christine; Masson, David; Bouvier, A; Fournel, Isabelle; Charles, Pierre‐Emmanuel; Rat, Patrick; Ortega‐Deballon, Pablo

doi:10.1097/sla.0000000000001303

Cited by 118 publications

(84 citation statements)

References 31 publications

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“…Studies have already proven that the surgical stress response can be evidenced by CRP concentrations on POD 3 or 4 [1, 7, 23]. Moreover, serum albumin acting as a negative acute-phase protein also decreases in response to surgical stress [24].…”

Section: Discussionmentioning

confidence: 99%

“…Baseline characteristics included age, sex, body mass index, American Society of Anesthesiologists (ASA) grade, comorbidities, and surgical indication. Laboratory data included hemoglobin, preoperative CRP and albumin, CRP on POD 3 [7], and albumin on POD 3 [13]. Intraoperative data included operation time, type of surgery, surgical approach (open vs laparoscopy), stoma creation, intraoperative blood transfusion, and estimated blood loss during surgery.…”

Section: Methodsmentioning

confidence: 99%

“…It is widely known that CRP is used to detect postoperative complications resulting from surgical injury. Additionally, several studies found CRP to be a useful tool to ensure a safe early discharge following colorectal surgery [7]. Warschkow et al [1] reported that CRP on postoperative day 3 or 4 (POD 4) had the best performance in predicting postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery

Cao

Wang

et al. 2017

World J Surg Onc

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BackgroundThe ratio of C-reactive protein to albumin, as a novel inflammation-based prognostic score, is associated with outcomes in cancer and septic patients. The diagnostic accuracy of the CRP/albumin ratio has not been assessed in colorectal surgery for postoperative complications.MethodsA total of 359 patients undergoing major colorectal surgery between 2012 and 2015 were eligible for this study. Uni- and multivariate analyses were performed to identify risk factors for postoperative complications. Receiver operating characteristic curves were developed to examine the cutoff values and diagnostic accuracy of the CRP/albumin ratio and postoperative CRP levels.ResultsAmong all the patients, 139 (38.7%) were reported to have postoperative complications. The CRP/albumin ratio was an independent risk factor for complications (OR 4.413; 95% CI 2.463–7.906; P < 0.001), and the cutoff value was 2.2, which had a higher area under the curve compared to CRP on postoperative day 3 (AUC 0.779 vs 0.756). The CRP/albumin ratio also had a higher positive predictive value than CRP levels on postoperative day 3. Patients with CRP/albumin ≥2.2 suffered more postoperative complications (60.8% vs 18.6%, P < 0.001), longer postoperative stays (10 (4–71) vs 7 (3–78) days, P < 0.001), and increased surgical site infections (SSIs) (21.1% vs 4.8%, P < 0.001) than those with CRP/albumin <2.2.ConclusionsThe ratio of C-reactive protein to albumin could help to identify patients who have a high probability of postoperative complications, and the ratio has higher diagnostic accuracy than C-reactive protein alone for postoperative complications in colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery

Cao

Wang

et al. 2017

World J Surg Onc

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“…Also, a meta-analysis including 2692 patients after colorectal surgery showed no advantage of PCT compared to CRP regarding diagnostic accuracy and mortality prediction [58]. This was confirmed recently in a similar large prospective study including 501 patients [59]. Thus, further investigation is needed in the surgical setting, and also to compare the accuracy and cost-effectiveness of PCT with other infection markers such as CRP.…”

Section: Introductionmentioning

confidence: 88%

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Sager

Kutz

Müeller

et al. 2017

BMC Med

240

181

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Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i.e., pneumonia). In these indications, PCT levels measured on hospital admission were found to substantially reduce the initiation of antibiotic treatment in low-risk situations (i.e., bronchitis, chronic obstructive pulmonary disease exacerbation). For more severe infections (i.e., pneumonia, sepsis), antibiotic stewardship by monitoring of PCT kinetics resulted in shorter antibiotic treatment durations with early cessation of therapy. Importantly, these strategies appear to be safe without increasing the risk for mortality, recurrent infections, or treatment failures. PCT kinetics also proved to have prognostic value correlating with disease severity (i.e., pancreatitis, abdominal infection) and resolution of illness (i.e., sepsis). Although promising findings have been published in these different types of infections, there are a number of limitations regarding PCT, including suboptimal sensitivity and/or specificity, which makes a careful interpretation of PCT in the clinical context mandatory. This narrative review aims to update clinicians on the strengths and limitations of PCT for patient management, focusing on research conducted within the last 4 years.

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“…Although both IL-6 and CRP are objective markers of the postoperative stress response and have both been associated with the development of complications following gastrointestinal surgery, CRP is routinely available in clinical practice [7]. colorectal surgery [51]. Furthermore, it has long been recognised that albumin is also a marker of the postoperative stress response [6], and is associated with postoperative complications and mortality [52].…”

Section: Discussionmentioning

confidence: 99%

The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis

McSorley

Horgan

McMillan

2016

Critical Reviews in Oncology/Hematology

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Highlights• Systematic review and meta-analysis of preoperative corticosteroids in surgery for GI cancers • Reports significant association between preoperative corticosteroids and lower postoperative IL-6 and CRP • The relationship between corticosteroids and lower postoperative systemic inflammatory response may underpin the impact on postoperative complications This meta-analysis examined the impact of preoperative corticosteroids on interleukin 6 (IL-6), C-reactive protein (CRP), and complications following surgery for gastrointestinal cancer. Keywords Methods:A systematic review was performed using appropriate keywords. Random-effects metaanalysis was performed.Results:11 RCTs with 474 patients, were included. Corticosteroids were significantly associated with lower IL-6 on postoperative day 1 (mean difference -148 pg/mL, 95% CI -205 to -92, p<0.001), 2 (-33 pg/mL, 95% CI -58 to -8, p=0.01), and 3 (-31 pg/mL, 95% CI -52 to -11, p=0.002), lower CRP on day 3 (-45 mg/L, 95% CI -68 to -21, p<0.001), and 7 (-14 mg/L, 95% CI -27 to -1, p=0.04), and fewer postoperative infective complications (OR 0.47, 95%CI 0.26 to 0.83, p=0.01). Conclusion:Corticosteroids were associated with reduction in the postoperative systemic inflammatory response and complications following surgery for gastrointestinal cancer.

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Diagnostic Accuracy of Inflammatory Markers As Early Predictors of Infection After Elective Colorectal Surgery

Abstract: C-reactive protein is more accurate than procalcitonin for the detection of infectious complications and should be systematically measured at the fourth postoperative day. It is a useful tool to ensure a safe early discharge after elective colorectal surgery.

Cited by 118 publications

References 31 publications

Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery

Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis

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