title: Persistent elevation of C-reactive protein following esophagogastric cancer resection as a predictor of postoperative surgical site infectious complications.
abstract: BACKGROUND
  Infectious complications, particularly in the form of anastomotic leaks (ALs) or surgical site infections (SSIs), represent a serious morbidity after esophagogastric cancer resections. Therefore, early detection is of paramount importance. Although markers of the systemic inflammatory response, including C-reactive protein (CRP) and white cell count (WCC), have been used in this regard, their relative predictive value is unclear. The aim of the present study was to examine serial postoperative WCC, albumin, and CRP and their diagnostic accuracy in case of infectious complications.
  
  
  METHODS
  White cell count, albumin, and CRP were routinely measured postoperatively for 7 days in 136 consecutive patients who had undergone esophagogastric cancer resection. All postoperative complications were recorded. The diagnostic accuracy of the WCC, albumin, and CRP values were analyzed by receiver operating characteristics curve analysis with surgical site and remote infectious complications as outcome measures.
  
  
  RESULTS
  Fifty-four (40%) patients developed infectious complications, and 17 of them developed an AL. CRP was significantly higher from postoperative day (POD) 3 onward in those patients who developed an AL. On POD 3, a threshold reading of 180 mg/l was associated with development of an AL, providing a sensitivity of 82% and a specificity of 63%. On POD 4, the same CRP threshold of 180 mg/l provided 71% sensitivity and 83% specificity.
  
  
  CONCLUSIONS
  Postoperative CRP measurements on PODs 3 and 4 are clinically useful in predicting surgical site infectious complications, in particular an AL, after resection for esophagogastric cancer.
authors.affiliation: University Department of Surgery, Faculty of Medicine, University of Glasgow, Royal Infirmary, Glasgow, UK. sdutta09@gmail.com
authors.forename: Sumanta
authors.initials: S
authors.lastname: Dutta
authors.forename: Grant M
authors.initials: GM
authors.lastname: Fullarton
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Forshaw
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D057868:Anastomotic Leak; D002097:C-Reactive Protein / Q000032:analysis*; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis; D013274:Stomach Neoplasms / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology*
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein