title: C-reactive protein on postoperative day 3 as a predictor of infectious complications following gastric cancer resection.
abstract: BACKGROUND
  Postoperative infectious complications (PICs) after gastric cancer resection remain a clinically relevant problem. Early detection of PICs, before critical illness develops, may be of considerable clinical benefit. The aims of this study were to investigate the predictive factors for PICs and to define the clinical parameters for detecting them early in patients with gastric cancer resection.
  
  
  METHODS
  Clinical data for 417 consecutive patients undergoing elective gastrectomy for primary gastric cancer between 2009 and 2012 were retrospectively analyzed. Diagnostic accuracy was determined by the area under the receiver operating characteristic curve (AUC). Univariate and multivariate logistic regression analyses identified clinical factors predicting PICs of grade III or more according to the Clavien-Dindo classification.
  
  
  RESULTS
  Forty-four patients developed PICs of grade ≥ III [10.6%, 95% confidence interval (CI) 7.6-13.5%]. As a systemic inflammatory marker, C-reactive protein (CRP) on postoperative day (POD) 3 had superior diagnostic accuracy for PICs (AUC 0.802, 95% CI 0.735-0.870) with a calculated cutoff value of 17.7 mg/dl, yielding a sensitivity of 0.66 (95% CI 0.524-0.774) and a specificity of 0.84 (95% CI 0.821-0.850). Multivariate analysis identified CRP on POD 3 of 17.7 mg/dl or greater [odds ratio (OR) 8.094, 95% CI 3.568-19.342) as well as clinical stage ≥ II (OR 4.445, 95% CI 1.478-15.881) and operation time ≥ 250 min (OR 3.638, 95% CI 1.449-10.137) as significant predictive factors for PICs after gastrectomy.
  
  
  CONCLUSIONS
  Elevated CRP levels on POD 3 will help physicians predict the postoperative course and facilitate decision-making regarding prompt, comprehensive clinical searches and therapeutic approaches for PICs.
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shishido
authors.affiliation: Department of Surgery, Osaka Prefectural General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan. fujitani@gh.opho.jp.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Fujitani
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirao
authors.affiliation: Department of Surgery, Kaizuka City Hospital, Kaizuka, Osaka, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Tsujinaka
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Sekimoto
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007239:Infections / Q000097:blood* / Q000209:etiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology; D011184:Postoperative Period; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Gastric cancer; Postoperative infectious complications