title: Rising C-reactive protein and procalcitonin levels precede early complications after esophagectomy.
abstract: BACKGROUND
  Elective esophagectomy with gastric tube reconstruction carries a high risk for complications. Early and accurate diagnosis could improve patient management. Increased C-reactive protein (CRP) levels may be associated with any, surgical or infectious, complication and procalcitonin (PCT) specifically with infectious complications.
  
  
  METHODS
  We measured CRP and PCT on post-operative days 0, 1, 2, and 3 in 45 consecutive patients. Complications were recorded up to 10 days post-esophagectomy.
  
  
  RESULTS
  Twenty-eight patients developed a post-operative complication (5 surgical, 14 infectious, 9 combined surgical/infectious, including anastomotic leakage), presenting on day 3 or later. Elevated days 2 and 3 and a rise in CRP preceded the diagnosis of general or combined surgical/infectious complications (minimum area under the receiver operating characteristics curve (AUROC) 0.75, P = 0.006). Elevated day 3 PCT preceded combined complications (AUROC 0.86, P < 0.001). High day 1 and 3 PCT levels preceded anastomotic leakage (minimum AUROC 0.76, P = 0.005), as did the day 3 CRP levels and their increases (minimum AUROC 0.78, P = 0.002).
  
  
  CONCLUSIONS
  This small study suggests that high or increasing CRP levels may precede the clinical diagnosis of general or surgical/infectious complications after esophagectomy. Elevated PCT levels may more specifically and timely precede combined surgical/infectious complications mainly associated with anastomotic leakage.
authors: Department of Intensive Care, Erasmus Medical Center, Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands, s.hoeboer@erasmusmc.nl.
authors: Sandra H
authors: SH
authors: Hoeboer
authors: A B Johan
authors: AB
authors: Groeneveld
authors: Noel
authors: N
authors: Engels
authors: Michel
authors: M
authors: van Genderen
authors: Bas P L
authors: BP
authors: Wijnhoven
authors: Jasper
authors: J
authors: van Bommel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D017558:Elective Surgical Procedures / Q000009:adverse effects; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D013530:Surgical Wound Infection / Q000097:blood / Q000175:diagnosis; D013997:Time Factors
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide