title: C-reactive protein 2 days after laparoscopic gastric bypass surgery reliably indicates leaks and moderately predicts morbidity.
abstract: BACKGROUND
  The aim of the present study was to evaluate whether serum C-reactive protein (CRP) is a useful predictor of early post-operative complications, particularly of intestinal leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery.
  
  
  METHODS
  The present study was a retrospective analysis of a prospectively maintained database with 809 patients who underwent LRYGB from 2002 until 2011. For 410 of these patients, at least one CRP measurement within the first seven post-operative days was available. The diagnostic value was determined by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  Forty-nine of 410 patients (12.0 %; 95 % confidence intervals [95 % CI], 9.2-15.5 %) developed surgery-related complications. Leaks occurred in 17 patients (4.1 %; 95 % CI, 2.6-6.5 %) at a median of 5 days after surgery. CRP levels 2 days after surgery showed the highest diagnostic value for post-operative complications (AUC, 0.74; 95 % CI, 0.60-0.89). Sensitivity was 0.53 (95 % CI, 0.31-0.74) and specificity was 0.91 (95 % CI, 0.79-0.96) on day 2 (cutoff level, 229 mg/l). The sensitivity for intestinal leaks was 1.00 (95 % CI, 0.51-1.00).
  
  
  CONCLUSIONS
  CRP on post-operative day 2 is a valuable predictor of post-operative complications, in particular intestinal leaks. Radiological imaging studies for intestinal leaks could be restricted to patients with CRP values exceeding 229 mg/l.
authors.affiliation: Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland. Rene.Warschkow@kssg.ch
authors.forename: Rene
authors.initials: R
authors.lastname: Warschkow
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
authors.forename: Patrick
authors.initials: P
authors.lastname: Folie
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beutner
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.forename: Philipp
authors.initials: P
authors.lastname: Bisang
authors.forename: Bernd
authors.initials: B
authors.lastname: Schultes
authors.forename: Martin
authors.initials: M
authors.lastname: Thurnheer
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein