Inflammatory markers as early predictors of infection after colorectal surgery: the same cut-off values in laparoscopy and laparotomy?

Facy, Olivier; Paquette, Brice; Orry, David; Santucci, Nicolas; Rat, P.; Rat, Patrick; Binquet, Christine; Ortega‐Deballon, Pablo

doi:10.1007/s00384-017-2805-9

Cited by 30 publications

(24 citation statements)

References 34 publications

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“…The CRP test is commonly used to indicate the presence of inflammation in many diseases. Many studies have confirmed its sensitivity in demonstrating inflammation after surgery [26–28]. Until now, there is no solid evidence to support its use before surgery, and none of the previous studies investigated its role in urolithiasis diseases.…”

Section: Discussionmentioning

confidence: 99%

Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery: Risk factors and predictive model

Sun

Lai

et al. 2018

The Kaohsiung J of Med Scie

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This paper investigates the characteristics of patients who underwent retrograde intrarenal surgery (RIRS) to determine the predictive factors for post-operative fever and systemic inflammatory response syndrome (SIRS) and to construct a predictive nomogram to help with risk-stratification. A retrospective study of 337 patients who underwent RIRS was performed. Fever and SIRS were defined according to a previous consensus. Multivariate logistic regression coefficients were used to generate nomograms. Post-operative fever was found in 59 patients (17.5%), and SIRS was found in 22 patients (6.5%). Septic shock developed in 2 patients (0.6%). Three patients (0.9%) suffered from obstructive hydronephrosis. By multivariate analysis, concomitant diabetes mellitus (p = 0.015), high pre-operative C-reactive protein (CRP) (p = 0.015), long surgical times (p = 0.007), high stone burden (p = 0.004) and positive stone culture (p = 0.003) were independent risk factors for fever. Only high pre-operative CRP (p = 0.001), long surgical times (p = 0.001) and high stone burden (p = 0.001) were found to significantly affect the occurrence of SIRS. Predictive nomograms were built for fever and SIRS and the c-statistics for the two predictive models were 0.766 and 0.887, respectively. All patients recovered well after proper treatment, which included antipyretics, antibiotics, and inotropic support and nephrostomy when needed. In conclusion, high stone burden, long surgical time, positive stone culture, high pre-operative CRP and the presence of diabetes mellitus was could increase the risk of fever or SIRS after RIRS for kidney stone. The constructed nomograms could help clinicians in evaluating the risk for post-operative infectious complications.

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Section: Discussionmentioning

confidence: 99%

Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery: Risk factors and predictive model

Sun

Lai

et al. 2018

The Kaohsiung J of Med Scie

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“…However, these outcomes were often rated poorly for validity and reliability by both the wider study group (in round 2) and the theme subgroup (in round 3). Although clinical teams continue to use these inflammatory markers, particularly CRP, to guide antibiotic therapy, 19,20 there is little evidence to ▪ Infection involves a part of the body deeper than the fascial/muscle layers, that is opened or manipulated during the operative procedure AND one of [purulent drainage from drain in organ/space OR organisms identified from aseptically obtained fluid or tissue in the organ space by a culture or non-culture based testing method which is performed for the purposes of clinical diagnosis and treatment OR an abscess or other evidence of infection involving the organ/space that is detected on gross histopathologic examination OR imaging test evidence suggestive of infection] ▪ Within 30 days y Sepsis z ▪ Increase in SOFA score of 2 or more, with evidence of infection ▪ Within 30 days y Septic Shock z ▪ Sepsis (SOFA score or 2 or more with evidence of infection) with shock ▪ Vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mM (>18 mg dl À1 ) in the absence of hypovolaemia suggest they reliably differentiate inflammation from infection. 21e24…”

Section: General Markers Of Infection and Inflammationmentioning

confidence: 99%

Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis

Barnes¹,

Hunter²,

Harris³

et al. 2019

British Journal of Anaesthesia

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Background: Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. Methods: We undertook a systematic review to identify measures of infection and sepsis used in the perioperative literature. A multi-round Delphi consensus process that included more than 60 clinician researchers was then used to refine a recommended list of outcome measures. Results: A literature search yielded 1857 titles of which 255 met inclusion criteria for endpoint extraction. A long list of endpoints, with definitions and timescales, was generated and those potentially relevant to infection and sepsis circulated to the theme subgroup and then the wider StEP-COMPAC working group, undergoing a three-stage Delphi process. The response rates for Delphi rounds 1, 3, and 3 were 89% (n¼8), 67% (n¼62), and 80% (n¼8), respectively. A set of 13 endpoints including fever, surgical site, and organ-specific infections as defined by the US Centres for Disease Control and Sepsis-3 are proposed for future use. Conclusions: We defined a consensus list of standardised endpoints related to infection and sepsis for perioperative trials using an established and rigorous approach. Each endpoint was evaluated with respect to validity, reliability, feasibility, and patient centredness. One or more of these should be considered for inclusion in future perioperative clinical trials assessing infection, sepsis, or both, thereby permitting synthesis and comparison of future results.

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“…The release of in ammatory factors is associated with postoperative complications including increased risk of postoperative infections (4)(5)(6)(7). In turn, sepsis is associated with increased rates of postoperative mortality, prolonged hospital stay, and increased health care costs (8).…”

Section: Introductionmentioning

confidence: 99%

“…Heparin-binding protein, also known as CAP37 or azurocidin, is a multifunctional, inactive serine-protease homologue (10). It is stored in azurophilic granules and secretory vesicles of neutrophils and released upon stimulation, and is able to recruit and activate monocytes, mobilize T cells and to induce detachment and homotypic aggregation of the endothelial cells (7,11). Furthermore, HBP has been shown to play a key role in inducing vascular leakage by mediating increased capillary permeability (12).…”

Section: Introductionmentioning

confidence: 99%

Dynamics of heparin binding protein in cardiothoracic surgery using cardiopulmonary bypass – exploring its potential as a marker for postoperative infections.

Sterner¹,

Fisher²,

Thelaus³

et al. 2020

Preprint

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Background Surgical trauma and cardiopulmonary bypass (CPB) cause an inflammatory response, difficult to differentiate from postoperative infections. Heparin-binding protein (HBP) is released from neutrophils and has been shown to predict infection-related organ dysfunction and disease progression to severe sepsis. The aim of this study was to investigate the pre-, intra- and postoperative dynamics of HBP in cardiac surgery using CPB, in order to explore the usefulness of HBP as a biomarker for postoperative infections. Methods and Results Thirty patients undergoing cardiac surgery with CPB were included, of which 15 underwent coronary artery bypass grafting (CABG) surgery and 15 underwent complex procedures with longer CPB time. A reference group of ten patients undergoing lung surgery without CPB was also included. HBP was measured at nine different time points during surgery. Our results showed that HBP levels were not affected by surgical trauma itself. An increase in HBP levels was observed immediately following heparin administration and further increased during CPB. Prior to protaminization, we measured higher peak in HBP-levels in the complex group 345.7 (287.8-472.6) ng/mL compared with the CABG group 152.7 (85.3-204.0) ng/mL, p <0.001. HBP decreased rapidly following end of CPB and simultaneous protamine administration. Delay of protamine administration revealed that protamine, and not the cessation of CPB is primarily responsible for the rapidly reduced HBP concentration. At the arrival to the ICU, the median HBP levels were 24.8 (15.6-38.1) ng/mL for CABG patients compared with 50.5 (36.5-104.6) ng/mL for complex surgery patients ( p =0.004). One day after surgery HBP levels in all three groups were below the proposed cutoff of 30 ng/mL previously found to predict development organ dysfunction during infection. There was a statistically significant correlation between CPB duration and peak HBP concentration (r=0.598, p =0.002). Conclusions HBP levels are elevated by administration of heparin and the use of CPB. However, at postoperative day one, HBP levels normalized regardless of surgical complexity, indicating that postoperative HBP measurement may be used as a screening tool for postoperative infections in cardiac surgery.

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Inflammatory markers as early predictors of infection after colorectal surgery: the same cut-off values in laparoscopy and laparotomy?

Abstract: The impact of infection on inflammatory markers is more important than that of the surgical approach. Defining a specific cutoff value for early discharge according to the surgical approach is not justified. A patient with CRP values lower than 100 mg/L on POD 4 can be safely discharged.

Cited by 30 publications

References 34 publications

Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery: Risk factors and predictive model

Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery: Risk factors and predictive model

Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis

Dynamics of heparin binding protein in cardiothoracic surgery using cardiopulmonary bypass – exploring its potential as a marker for postoperative infections.

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