title: C-reactive protein as an early predictor for anastomotic leakage in elective abdominal surgery.
abstract: BACKGROUND
  Anastomotic leakage (AL) represents a serious complication after abdominal surgery. Therefore, it is important to detect it early before it becomes clinically apparent. The predictive value of C-reactive protein (CRP) as a marker of infective postoperative complications, particularly in the form of anastomotic leakage, has been investigated by several authors with promising results. The aim of this study was to evaluate the diagnostic accuracy of C-reactive protein in predicting anastomotic leakage.
  
  
  METHODS
  The serum CRP level, white blood cell (WBC) count, and body temperature (BT) of 156 patients who underwent elective abdominal surgery with primary anastomosis were monitored daily until postoperative day (POD) 7. We recorded all postoperative complications and analyzed the data. Diagnostic accuracy of CRP with regard to development of AL was assessed by receiver operating characteristic curve analysis.
  
  
  RESULTS
  Fifteen patients (9.6 %) developed anastomotic leakage. CRP was significantly higher every day during the first 7 postoperative days in patients who developed AL compared with those patients who did not develop complications, whereas the WBC count and BT were not. A CRP cutoff value of 135 mg/l on POD 3 yielded a sensitivity of 73 %, a specificity of 73 %, and a negative predictive value of 95.4 % for the detection of AL.
  
  
  CONCLUSIONS
  According to our results, values of CRP less than 135 mg/l on POD 3 may contribute to a safe discharge from hospital. Patients with CRP values higher than 135 mg/l on POD 3 require prolonged hospitalization and an intensive search for infective complications, particularly AL.
authors.affiliation: Zvezdara University Clinical Centre, Belgrade, Serbia and Montenegro, mimadr10@yahoo.co.uk.
authors.forename: M S
authors.initials: MS
authors.lastname: Scepanovic
authors.forename: B
authors.initials: B
authors.lastname: Kovacevic
authors.forename: V
authors.initials: V
authors.lastname: Cijan
authors.forename: A
authors.initials: A
authors.lastname: Antic
authors.forename: Z
authors.initials: Z
authors.lastname: Petrovic
authors.forename: R
authors.initials: R
authors.lastname: Asceric
authors.forename: I
authors.initials: I
authors.lastname: Krdzic
authors.forename: V
authors.initials: V
authors.lastname: Cuk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein