Rising C-Reactive Protein and Procalcitonin Levels Precede Early Complications After Esophagectomy

Hoeboer, Sandra H.; Groeneveld, A. B. Johan; Engels, Noel; Genderen, Michel E van; Wijnhoven, Bas P. L.; Bommel, Jasper van

doi:10.1007/s11605-015-2745-z

Cited by 51 publications

(53 citation statements)

References 29 publications

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“…AUC, area under the curve; CI, confidence interval; CRP, C-reactive protein; NPV, negative predictive value; PPV, positive predictive value. 20 as well as in a recent study by Hoeboer et al, 21 supporting our finding that a rise in CRP precedes the clinical manifestation of the leak. It is thought that the majority of leaks are due to impaired perfusion rather than technical issues, 22,23 and this early CRP rise may reflect ischaemia occurring within 48 h of surgery prior to onset of clinical signs of sepsis.…”

Section: Discussionsupporting

confidence: 93%

C‐reactive protein is a useful negative predictor of anastomotic leak in oesophago‐gastric resection

Gordon

Cross

Foo

et al. 2016

ANZ Journal of Surgery

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Section: Discussionsupporting

confidence: 93%

C‐reactive protein is a useful negative predictor of anastomotic leak in oesophago‐gastric resection

Gordon

Cross

Foo

et al. 2016

ANZ Journal of Surgery

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“…There are many prior studies evaluating anastomotic leak after esophagectomy (4,9,10,14,16). The literature suggests that elevated CRP after esophagectomy is a marker that can be used for early detection of postoperative complications after esophagectomy (11,17,18). CRP is an …”

Section: Discussionmentioning

confidence: 99%

“…Instead, the postoperative CRP value is the only useful marker in the prediction of postoperative anastomotic leak, which is applicable in both NT and non-NT. Procalcitonin and interleukin-6 have been previously reported to be potential predictors of surgical complications after surgery (18). However, given that these markers are not included in routine laboratory tests, are not well-establish, and are expensive, we did not analyze these results.…”

mentioning

confidence: 99%

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

Park¹,

Kim²,

Moon³

2017

J. Thorac. Dis.

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Background: Anastomotic leak is one of most significant causes of mortality after esophagectomy. Therefore, it is clinically valuable to detect anastomotic leak early after esophagectomy in esophageal cancer. The purpose of this study is to investigate the associations between routine postoperative laboratory findings and anastomotic leak and to analyze the laboratory findings to find out an independent predictive marker for anastomotic leak.In addition, this study compares cases treated with neoadjuvant therapy (NT) and those without (non-NT). Methods:We retrospectively assessed the medical records of 201 consecutive cases that met this study's criteria from January 2009 to December 2016. All patients underwent curative and complete esophagectomy for intra-thoracic esophageal cancer. We compiled and analyzed routine laboratory findings from the day before surgery to the eighth postoperative day on a daily basis. Routine laboratory tests consisted of 26 separate tests, including complete blood cell counts, blood chemistries, as well as erythrocyte sedimentation rate and C-reactive protein (CRP). Barium esophagogram with chest computed tomography (CT) was performed on the seventh postoperative day to evaluate the presence of an anastomotic leak.Results: A total of 45 of 201 patients underwent NT. Anastomotic leaks were found in 23 (11.4%) of 201 patients (8 patients in NT and 15 patients in non-NT). White blood cell (WBC) from the second postoperative day (P=0.031, P=0.006, P=0.007, P=0.007, P=0.041, and P=0.003, respectively) and CRP from the third postoperative day (P=0.012, P<0.001, P=0.014, P<0.001, P=0.001, and P=0.006, respectively) were associated with anastomotic leak in non-NT; however, only CRP on the third, fifth, sixth, and seventh postoperative days (P=0.041, P=0.037, P=0.002, and P=0.003, respectively) was associated with anastomotic leak in NT. The CRP level on the third postoperative day was a significant independent predictive marker of anastomotic leak (P=0.041, odd ratio (OR) 1.056, 95% confidential interval (CI): 1.002-1.113) and had a significant diagnostic cutoff value for the development of anastomotic leak (non-NT: cutoff value 17.12 mg/dL, sensitivity 69.2%, specificity 78.1%, P<0.001, area 0.822; NT: cutoff value 16.42 mg/dL, sensitivity 80.0%, specificity 70.0 %, P=0.042, area 0.7104).Conclusions: There were divergent laboratory findings reflective of anastomotic leak between patients who underwent NT and those who did not. The CRP level on the third postoperative day had a significant cutoff value for early detection of anastomotic leak after esophagectomy in both NT and non-NT groups.

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“…The optimal intended use scenario for SeptiCyte LAB therefore requires further exploration. Our data suggest that adding SeptiCyte LAB to CRP may improve diagnostic discrimination in patients following major surgery [9][10][11][12]. However, any possible use of SeptiCyte LAB for routine screening of such postoperative patients will require careful evaluation before it can be recommended, as the test will probably be more expensive than alternative biomarkers that are routinely available.…”

Section: Discussionmentioning

confidence: 91%

“…Although these biomarkers have adequate negative predictive values (ranging from 91% to 100%), their positive predictive values remain poor [9][10][11][12][13]. A variety of alternative biomarkers have thus been proposed for the diagnosis of sepsis, however their diagnostic accuracy is variable across settings and their clinical utility not always evident [5,6].…”

Section: Introductionmentioning

confidence: 99%

A pilot study of a novel molecular host response assay to diagnose infection in patients after high-risk gastro-intestinal surgery

Verboom

Koster‐Brouwer

Ruurda

et al. 2018

Preprint

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AimSeptiCyte LAB measures the expression of four host-response RNAs in blood to distinguish sepsis from sterile inflammation. Sequential monitoring of this assay may have diagnostic utility in patients at high risk for postoperative infectious complications. MethodsIn this pilot study we studied esophagectomy patients who had developed a complication within 30 days following surgery as well as a random sample of 100 uncomplicated postoperative patients. PAXgene blood samples were collected postoperatively and whenever a complication occurred. SeptiCyte scores (ranging 0-10 with increasing likelihood of infection) were compared to post-hoc physician adjudication of infection likelihood using strict definitions. ResultsAmong 370 esophagectomy patients, 120 (32%) subjects developed a complication requiring ICU (re)admission, 63 (53%) of whom could be analyzed. Immediate postoperative SeptiCyte LAB scores were highly variable, yet similar for patients having a complicated and uncomplicated postoperative course (median score of 2.4 (IQR 1.6-3.3) versus 2.2 (IQR 1.3-3), respectively). Scores increased as complications developed, but this rise was higher for 34 subjects having confirmed infection (median difference 4.7 (IQR 4.1-5.8)) then for 12 subjects with a non-infectious complication (2.1 (IQR 0.4-3.6); p<0.0001). When 17 cases with undetermined infectious status were excluded, addition of SeptiCyte LAB to CRP resulted in improved diagnostic discrimination (AUC 0.88 (95%CI 0.77-0.99)) compared to CRP alone (AUC 0.76 (95%CI 0.61-0.91); p=0.04). ConclusionsSequential measurement of SeptiCyte LAB may have clinical utility in surgical patients at high risk of postoperative infection, but its diagnostic performance in this setting needs to be further evaluated.

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Rising C-Reactive Protein and Procalcitonin Levels Precede Early Complications After Esophagectomy

Cited by 51 publications

References 29 publications

C‐reactive protein is a useful negative predictor of anastomotic leak in oesophago‐gastric resection

C‐reactive protein is a useful negative predictor of anastomotic leak in oesophago‐gastric resection

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

A pilot study of a novel molecular host response assay to diagnose infection in patients after high-risk gastro-intestinal surgery

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