C-reactive protein as early predictor for infectious postoperative complications in rectal surgery.
BACKGROUND
This study evaluated the role of the acute phase C-reactive protein (CRP) in the postoperative course of a large series of rectal resections on the basis of a prospective database. Main focus of this study was the early identification of complications.


METHODS
Three hundred eighty-three rectal resections with primary anastomosis for rectal cancer were screened for infectious postoperative complications. Forty-eight complicated cases were identified and matched with 48 patients with an uneventful postoperative course.


RESULTS
In the postoperative setting, CRP peaked on postoperative day (POD) 2 with a median serum CRP of 140 mg/l and gradually declined thereafter in uncomplicated cases. In complicated cases, CRP elevation generally persisted after POD 2, whereas white blood cells and body temperature were within normal range in the early postoperative period. A cutoff CRP value of 140 mg/dl on PODs 3 and 4 resulted in predictive values of 85.7 and 90.5% (adjusted to the prevalence: 37.6 and 50.3%), sensitivities of 80.0 and 54.3%, and specificities of 81.0 and 92.3% for a complicated postoperative course (P<0.001), respectively.


CONCLUSIONS
Persistent CRP elevation and elevation of serum CRP above 140 mg/dl on PODs 3-4 are predictive of infectious postoperative complications and should prompt intense clinical search for an inflammatory process, especially for an anastomotic leak if pneumonia and wound infection are unlikely or excluded.
Welsch
T
T
Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Müller
S A
SA
Ulrich
A
A
Kischlat
A
A
Hinz
U
U
Kienle
P
P
Büchler
M W
MW
Schmidt
J
J
Schmied
B M
BM
D000368:Aged; D000714:Anastomosis, Surgical; D015415:Biomarkers / Q000097:blood; D001831:Body Temperature; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012004:Rectal Neoplasms / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D002097:C-Reactive Protein