Diagnostic and predictive value of the silkworm larvae plasma test for postoperative infection following gastrointestinal surgery.
OBJECTIVE
To determine whether the silkworm larvae plasma (SLP) test is a reliable diagnostic marker of infection in patients with infectious complications following gastrointestinal surgery.


METHODS
Prospective study.


METHODS
Department of Surgery, University Hospital, Shiga University of Medical Science.


METHODS
One hundred and twelve adult patients undergoing gastrointestinal surgery


METHODS
None.


RESULTS
Thirty-nine of 112 patients developed infectious complications (infected group). Seven patients with sepsis (severely infected group) and 32 patients without sepsis (minor infected group) were observed. The operation time, blood loss, and age were significantly greater in both infected groups than in the noninfected group. The systemic inflammatory response syndrome score on postoperative day (POD) 1 and POD7 was highest in the severely infected group. The increase in C-reactive protein on POD3 and POD7 was significantly higher in both infected groups than in the noninfected group. White blood cell counts on POD7 were elevated significantly higher in the severely infected group than in the other groups. Immediately after surgery, SLP activity significantly increased compared with presurgery in all groups and was significantly higher in the minor and severely infected groups than in the noninfected group. The increased SLP activity returned to preoperative levels in the minor and noninfected groups; however, SLP activity in the severely infected groups remained high throughout the observational period. The most significant factor and time point that predicted infectious complications were the SLP test on POD1; sensitivity 66.7%, specificity 90.4%, positive and negative predictive values 78.8% and 83.5%. The area under the receiver operating characteristic curve for the SLP test was 0.813 +/- 0.046.


CONCLUSIONS
The SLP test appears to be a useful marker of diagnosis and prediction of infectious complications following gastrointestinal surgery. Moreover, the SLP test may be able to evaluate not only the existence but also the severity of infection in surgical patients.
Shimizu
Tomoharu
T
Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga, Japan.
Endo
Yoshihiro
Y
Tabata
Takahisa
T
Mori
Tsuyoshi
T
Hanasawa
Kazuyoshi
K
Tsuchiya
Masakazu
M
Tani
Tohru
T
D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D013505:Digestive System Surgical Procedures; D004731:Endotoxins / Q000097:blood; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D010457:Peptidoglycan / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology
D015415:Biomarkers; D004731:Endotoxins; D010457:Peptidoglycan; D002097:C-Reactive Protein