Diagnostic study and meta‐analysis of C‐reactive protein as a predictor of postoperative inflammatory complications after pancreatic surgery

Abstract

According to this limited evidence, CRP levels had a low to moderate diagnostic accuracy. Large, blinded studies are warranted for a more precise estimation of CRP's diagnostic value.

Behandlung postoperativer Passagestörungen, Cholangitis und Pankreatitis

“…Trotzdem ist die Ausbildung einer klinisch apparenten Cholangitis eine eher seltene Komplikation und tritt meist nur bei einer Behinderung des Galleflusses auf. Ihre Häufig-keit wird in Abhängigkeit vom operativen Eingriff mit 1-10 % nach Pankreaseingriffen und 17-60 % nach Lebertransplantation angegeben [33, 53,63]. Die eindeutige Diagnose einer postoperativen Cholangitis ist im intensivmedizinischen Setting häufig schwierig.…”

Role of C-Reactive Protein Assessment as Early Predictor of Surgical Site Infections Development after Pancreaticoduodenectomy

“…The authors suggested an algorithm with early CT scan on 4th postoperative day based on CRP value. In 2012, Warschkow et al [22] similarly analyzed CRP value in prediction of global IPC on a series of 280 pancreatic surgical procedures including PD, left pancreatectomy, total pancreatectomy and cystojejunostomy; in their experience, IPC prevalence was equal to 54.6%, but CRP did not appear capable of predicting IPC development with adequate accuracy.…”

“…In this regard, CRP appears in our experience to be a helpful tool in clinical practice, even if its use should be rationalized, since CRP predictive power for septic complications is not uniform during the overall postoperative course [22,23,25]. In the first 2 postoperative days, the physiologic response to surgical stress hides the effects on CRP levels of an ongoing septic process, making its assay useless and, moreover, generating a small but unjustified extra cost.…”

“…Several authors focused on high grade or clinically significant pancreatic fistula (ISGPF B-C) [22], as this complication radically differs from indolent pancreatic fistula. High grade fistula can have a dramatic impact on postoperative course, justifying the great part of risks, costs and length of hospital stay among patients undergoing PD and occasionally leading to other potentially life threatening situations, such as late postoperative bleedings [6,13,14].…”

“…In recent years, different authors have started to investigate the predictive role on postoperative morbidity of different laboratory assays, including serum albumin, aminotransferase and blood urea nitrogen [20], retrospectively considering large surgical series and often including pancreatic resections in their study population [21]. The primary outcomes varied, as they alternatively highlighted overall morbidity, global inflammatory complications [22,23] or, more selectively, POPF development [11,24]; furthermore, some authors proposed a series containing a combination of different surgical procedures [22], thus weakening the predictive power on complications development. With regards to POPF occurrence, several authors focused on the search for a combination of variables, using both laboratory and clinical data, such as body temperature or drainage fluid appearance.…”