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

Abstract

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.

Relationship between C‐reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris

“…Merging albumin and CRP into a single index is demonstrated to be associated with poor prognosis in a variety of disorders including cancer and sepsis . We assumed that increased CRP/albumin ratio indicates a higher inflammatory state and may be superior to CRP and albumin alone in determining the prevalence and severity of CAD.…”

Early Inflammatory Biomarkers as Predictive Factors for Freedom from Infection after Colorectal Cancer Surgery: A Prospective Cohort Study

“…For many surgeons, the early identification of SSI is still a challenge. In the period after elective colorectal surgery, SSI can lead to prolonged hospital stays, increased morbidity and [5]. Despite the combined evaluation of clinical, laboratory, and radiologic findings, early diagnosis of SSI cannot be made reliably by any known individual feature or even by experienced clinical judgment [9].…”

“…The research on CAR is still in development. Ge et al [5] found that patients with CAR >2.2 on POD3 should be monitored intensively for early detection of post-operative complications. Shibutani et al [16] found pre-operative CAR to be a useful prognostic marker in patients with colorectal cancer undergoing potentially curative surgery.…”

“…Several biomarkers of infection, namely white blood cell (WBC) count and C-reactive protein (CRP) and procalcitonin (PCT) concentrations, have proved useful in the diagnosis of infection in different clinical settings as well as in the assessment of its response to antibiotic therapy [2][3][4]. Also, a low serum albumin concentration is associated with post-operative complications [5,6].…”

“…However, there still is no consensus regarding the diagnostic accuracy of each one for early detection of complications in patients undergoing colorectal surgery [3,9,12,13]. However, the CRP-to-albumin ratio (CAR) has received almost no studies to determine its diagnostic accuracy for post-operative complications in patients undergoing colorectal surgery [5]. The aim of this work was to clarify the relation between different inflammatory biomarkers (WBC, CRP, PCT, and CAR) and early infectious complications of colorectal surgery.…”