title: Can C-reactive protein predict the severity of a post-operative complication after elective resection of colorectal cancer?
abstract: OBJECTIVE
  To explore if post-operative day 3 C-reactive protein (CRP), the ratio of pre-operative to day 3 white cell count (WCC) and platelet count can be used to predict the risk of post-operative complication and stratify the severity of complications as defined by the Clavien-Dindo classification.
  
  
  METHODS
  Data was obtained retrospectively on 127 patients who had elective bowel resection for malignancy between 2011 and 2013. Baseline demographics and clinical details were obtained including pre-operative and day 3 WCC and platelets and day 3 CRP. Ratio of pre-operative to day 3 WCC and platelets was calculated. Outcome measures were if a complication occurred (death included) and complication as defined by the Clavien-Dindo clasification. Mann-Whitney U test and Kruskal-Wallis were used to test for significance.
  
  
  RESULTS
  Of 127 patients, 57 % (n = 73) were male with a total median age of 72 and the commonest histology result T3N0 (40.6 %, n = 52). CRP was found to predict a complication (p < 0.0005) and the severity of complication as per the Clavien-Dindo classification (p < 0.0005). Day 3 CRP over 285 suggested a life-threatening complication (Clavien-Dindo score 4). There was no statistical significance between the ratio of WCC and platelets to any of the outcome measures.
  
  
  CONCLUSIONS
  WCC, platelets and CRP are routinely performed in the post-operative period. Previous research has shown CRP to be a good predictor of a complication. This paper has shown that day 3 CRP can not only predict but can also stratify the severity of post-operative complications.
authors: Foundation School, Hillingdon Hospital, Pield Heath Road, Uxbridge, UB8 3NN, UK, jamespselby@gmail.com.
authors: James
authors: J
authors: Selby
authors: Ash
authors: A
authors: Prabhudesai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D010976:Platelet Count; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein