title: C-reactive protein kinetics after major surgery.
abstract: BACKGROUND
  Diagnosis of sepsis in the postoperative period is a challenge. Measurements of inflammatory markers, such as C-reactive protein (CRP), have been proposed in medical patients, but the interpretation of these values in surgical patients is more difficult. We evaluated the changes in blood CRP levels and white blood cell count in postoperative patients with and without infection.
  
  
  METHODS
  All patients admitted to our 34-bed Department of Intensive Care after major (elective or emergency) cardiac, neuro-, vascular, thoracic, or abdominal surgery during a 4-month period were prospectively included. Patients were screened daily and characterized as infected or noninfected. CRP levels and white blood cell counts were recorded daily in all patients for up to 7 days after the surgical intervention.
  
  
  RESULTS
  Of the 151 patients enrolled, 115 underwent elective surgery and 36 emergency surgery; cardiac surgery was performed in 49 patients, neurosurgery in 65, abdominal surgery in 25, vascular surgery in 7, and thoracic surgery in 5. In noninfected patients (n = 117), mean CRP values increased from baseline to postoperative day (POD) 3 (P < 0.0001, estimated mean difference [EMD] = 99.7 mg/L [95% confidence interval, 85.6-113.8]) and then decreased until POD 7 but remained higher than the level at baseline (P < 0.0001, EMD = 49.2 mg/L [95% confidence interval, 27.1-71.2]). Postoperative infection occurred in 20 patients (13.2%). In these patients, CRP values were already higher on POD 1 than in noninfected patients (P = 0.0054).
  
  
  CONCLUSIONS
  CRP levels increase in the first week after major surgery but to a much larger extent in infected than in noninfected patients. Persistently high CRP levels after POD 4, especially when >100 mg/L, suggest the presence of a postoperative infection.
authors.affiliation: From the Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; and †Department of Intensive Care, AOU Policlinicao-Vittorio Emanuele, Univerità degli Studi di Catania, Catania, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Santonocito
authors.forename: Isabelle
authors.initials: I
authors.lastname: De Loecker
authors.forename: Katia
authors.initials: K
authors.lastname: Donadello
authors.forename: Mouhamed D
authors.initials: MD
authors.lastname: Moussa
authors.forename: Samuel
authors.initials: S
authors.lastname: Markowicz
authors.forename: Antonino
authors.initials: A
authors.lastname: Gullo
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D018806:APACHE; D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism*; D016001:Confidence Intervals; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000378:metabolism; D007362:Intensive Care Units; D007700:Kinetics; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality; D013530:Surgical Wound Infection / Q000097:blood / Q000401:mortality
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein