Postoperative variation of C-reactive protein and procalcitonin in patients with gastrointestinal cancer.
BACKGROUND
Despite substantial advances in radiotherapy, chemotherapy and immunotherapy, surgical management remains the standard of care, especially in patients with no evidence of distant metastases and who are fit for surgery. It is traditionally known, however, that patients undergoing surgery for gastrointestinal malignancies suffer from a high rate of infective complications and there is little information on the behavior of C-Reactive Protein (CRP) and procalcitonin (PCT) in these patients.


METHODS
The study population included 18 consecutive patients with untreated gastric (n = 6) or colorectal (n = 12) carcinoma and 18 control subjects. Blood samples were collected from cancer patients the day before surgery and on the following 1, 7, 30 postoperative days. Results of PCT and CRP were corrected for plasma volume changes.


RESULTS
Pre-surgery values of CRP, but not of PCT, were significantly higher in cancer patients than in controls. Both markers in patients without postoperative infections reached peak-levels on day 1. On day seven, CRP values were still significantly increased, while those of PCT were non statistically different from pre-surgery. By receiver operating characteristic (ROC) analysis, both PCT and CRP discriminated patients with or without pneumonia on the day 7 post-surgery, but not between patients with or without surgical wound infection.


CONCLUSIONS
Taken together, our findings are consistent with the hypothesis that PCT might be a more useful marker than CRP for monitoring the postoperative course and diagnose severe perioperative bacterial infections in patients undergoing surgery for gastrointestinal malignancies after the 7th postoperative day.
Montagnana
Martina
M
Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy. martina.montagnana@med.lu.se
Minicozzi
Anna Maria
AM
Salvagno
Gian Luca
GL
Danese
Elisa
E
Cordiano
Claudio
C
De Manzoni
Giovanni
G
Guidi
Gian Cesare
GC
Lippi
Giuseppe
G
D001424:Bacterial Infections / Q000453:epidemiology; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood / Q000175:diagnosis; D008991:Monitoring, Physiologic / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D011184:Postoperative Period; D011498:Protein Precursors / Q000097:blood*; D012016:Reference Values; D013274:Stomach Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014945:Wound Healing
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide