title: C-reactive protein is an early predictor of septic complications after elective colorectal surgery.
abstract: BACKGROUND
  Nowadays, most patients who undergo colorectal surgery are discharged early. An early predictor of septic complications could avoid readmissions and decrease morbidity. CRP could be a good predictor allowing a safe discharge.
  
  
  METHODS
  A prospective, observational study was conducted from November 2007 to October 2008. All patients who underwent elective colorectal surgery were included. Clinical (temperature, pulse, abdominal tenderness, bowel movements) and laboratory data (C-reactive protein, leukocyte count) were recorded and evaluated as early predictors of septic complications (namely, anastomotic leaks). All detected leaks were considered fistulas, independently of their clinical significance. Clinical and inflammatory parameters were analyzed with univariate and multivariate techniques; logistic regression was performed and areas under the receiver operating characteristic curve were compared.
  
  
  RESULTS
  A total of 133 patients were included. The overall incidence of anastomotic leaks was 15.5% and mortality was 4.5%. C-reactive protein at postoperative days 2 and 4 was a good predictor of anastomotic leak (areas under the curve were 0.715 and 0.845, respectively) and other postoperative septic complications (areas under the curve were 0.804 and 0.787), showing the highest accuracy among clinical and laboratory data. A cutoff of 125 mg/l in the level of C-reactive protein at postoperative day 4 yielded a sensitivity of 81.8% and a negative predictive value of 95.8% for the detection of anastomotic leakage.
  
  
  CONCLUSIONS
  C-reactive protein is a simple way to ensure a safe discharge from hospital after elective colorectal surgery. Patients with CRP values >125 mg/l on the fourth postoperative day should not be discharged.
authors.affiliation: Service de Chirurgie Digestive, Thoracique et Cancérologique, Centre Hospitalier Universitaire du Bocage, 1, Bd. Jeanne d'Arc, 21079, Dijon Cedex, France. pablo.ortega-deballon@chu-dijon.fr
authors.forename: Pablo
authors.initials: P
authors.lastname: Ortega-Deballon
authors.forename: François
authors.initials: F
authors.lastname: Radais
authors.forename: Olivier
authors.initials: O
authors.lastname: Facy
authors.forename: Philippe
authors.initials: P
authors.lastname: d'Athis
authors.forename: David
authors.initials: D
authors.lastname: Masson
authors.forename: Pierre E
authors.initials: PE
authors.lastname: Charles
authors.forename: Nicolas
authors.initials: N
authors.lastname: Cheynel
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Favre
authors.forename: Patrick
authors.initials: P
authors.lastname: Rat
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003107:Colorectal Surgery; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D018805:Sepsis / Q000097:blood*
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein