The Effect of Gender, Age and BMI on Postoperative C-Reactive Protein Levels After Major Abdominal Surgery

Straatman, Jennifer; Harmsen, Annelieke M. K.; Cuesta, Miguel A.; Lange, Elly S. M. de; Peet, Donald L. van der

doi:10.14740/jcs236w

Cited by 2 publications

(2 citation statements)

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“…Previous research has indicated that patient factors such as sex, age, and BMI, have a negligible effect on postoperative CRP levels. 34 In addition, the present results indicate that surgical indication, smoking status, or additional HIPEC did not significantly influence CRP levels. Conversely, combining CRP with other markers, such as intestinal fatty acid binding protein and interleukin-6, might increase its diagnostic value.…”

Section: Discussionsupporting

confidence: 43%

C-reactive protein after major abdominal surgery in daily practice

Plat

Voeten

Daams

et al. 2021

Surgery

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Background: Infectious complications are frequently encountered after abdominal surgery. Early recognition, diagnosis, and subsequent timely treatment is the single most important denominator of postoperative outcome. This study prospectively addressed the predictive value of routine assessment of Creactive protein levels as an early marker for infectious complications after major abdominal surgery. Methods: Consecutive patients undergoing major abdominal surgery between November 2015 and November 2019 were prospectively enrolled. Routine C-reactive protein measurements were implemented on postoperative days 3, 4, and 5, and additional computed tomography examinations were performed on demand. The primary endpoint was the occurrence of Clavien-Dindo grade III or higher infectious complications. Results: Of 350 patients, 71 (20.3%) experienced a major infectious complication, and median time to diagnosis was 7 days. C-reactive protein levels were significantly higher in patients with major infectious complications compared to minor or no infectious complications. The optimal cut-off was calculated for each postoperative day, being 175 mg/L on day 3, 130 mg/L on day 4, and 144 mg/L on day 5, and corresponding sensitivities, specificities, and positive and negative predictive values were over 80%, 65%, 40%, and 92% respectively. Alternative safe discharge cut-offs were calculated at 105 mg/L, 71 mg/L and 63 mg/L on days 3, 4, and 5, respectively, each having a negative predictive value of over 97%. Conclusion:The C-reactive protein cut-offs provided in this study can be used as a discharge criterion or to select patients that might require an invasive intervention due to infectious complications. These diagnostic criteria can easily be implemented in daily surgical practice.

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Section: Discussionsupporting

confidence: 43%

C-reactive protein after major abdominal surgery in daily practice

Plat

Voeten

Daams

et al. 2021

Surgery

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“…In uneventful cases, the levels decrease after this peak [ 24 ]. Furthermore, the plasma half-life of CRP is 19 hours and postoperative CRP levels are independent of gender, age, body mass index (BMI), diet, diurnal rhythm or organ function [ 25 ]. Circulating CRP levels are therefore only determined by their rate of synthesis [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

The PRECious trial PREdiction of Complications, a step-up approach, CRP first followed by CT-scan imaging to ensure quality control after major abdominal surgery: study protocol for a stepped-wedge trial

Straatman

Cuesta

Schreurs

et al. 2015

Trials

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BackgroundAfter major abdominal surgery (MAS), 20 % of patients endure major complications, which require invasive treatment and are associated with increased morbidity and mortality. A quality control algorithm after major abdominal surgery aimed at early identification of patients at risk of developing major complications can decrease associated morbidity and mortality. Literature studies show promising results for C-reactive protein (CRP) as an early marker for postoperative complications, however clinical significance has yet to be determined.MethodsA multicenter, stepped wedge, prospective clinical trial including all adult patients planned to undergo elective MAS. The first period consists of standard postoperative monitoring, which entails on demand additional examinations. This is followed by a period with implementation of postoperative control according to the PRECious protocol, which implicates standardized measurement of CRP levels. If CRP levels exceed 140 mg/L on postoperative day 3,4 or 5, an enhanced CT-scan is performed.Primary outcome in this study is a combined primary outcome, entailing all morbidity and mortality due to postoperative complications. Complications are graded according to the Clavien-Dindo classification. Secondary outcomes are hospital length of stay, patients reported outcome measures (PROMs) and cost-effectiveness. Data will be collected during admission, three months and one year postoperatively. Approval by the medical ethics committee of the VU University Medical Center was obtained (ID 2015.114).Discussionthe PRECious trial is a stepped-wedge, multicenter, open label, prospective clinical trial to determine the effect of a standardized postoperative quality control algorithm on postoperative morbidity and mortality, and cost-effectiveness.Trial registrationwww.ClinicalTrials.gov, NCT02102217. Registered 5 February 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0903-y) contains supplementary material, which is available to authorized users.

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The Effect of Gender, Age and BMI on Postoperative C-Reactive Protein Levels After Major Abdominal Surgery

Abstract: Background: The aim of this observational study was to analyze whether differences exist in postoperative C-reactive protein (CRP) levels in elderly, obese or for gender after major abdominal surgery, which might affect the diagnostic value of CRP.

Cited by 2 publications

References 29 publications

C-reactive protein after major abdominal surgery in daily practice

C-reactive protein after major abdominal surgery in daily practice

The PRECious trial PREdiction of Complications, a step-up approach, CRP first followed by CT-scan imaging to ensure quality control after major abdominal surgery: study protocol for a stepped-wedge trial

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