Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis.
OBJECTIVE
Infectious complications occur frequently after major abdominal surgery and have a major influence on patient outcome and hospital costs. A marker that can rule out postoperative infectious complications (PICs) could aid patient selection for safe and early hospital discharge. C-reactive protein (CRP) is a widely available, fast, and cheap marker that might be of value in detecting PIC. Present meta-analysis evaluates the diagnostic value of CRP to rule out PIC following major abdominal surgery, aiding patient selection for early discharge.


METHODS
A systematic literature search of Medline, PubMed, and Cochrane was performed identifying all prospective studies evaluating the diagnostic value of CRP after abdominal surgery. Meta-analysis was performed according to the PRISMA statement.


RESULTS
Twenty-two studies were included for qualitative analysis of which 16 studies were eligible for meta-analysis, representing 2215 patients. Most studies analyzed the value of CRP in colorectal surgery (eight studies). The pooled negative predictive value (NPV) improved each day after surgery up to 90% at postoperative day (POD) 3 for a pooled CRP cutoff of 159 mg/L (range 92-200). Maximum predictive values for PICs were reached on POD 5 for a pooled CRP cutoff of 114 mg/L (range 48-150): a pooled sensitivity of 86% (95% confidence interval (CI) 79-91%), specificity of 86% (95% CI 75-92%), and a positive predictive value of 64% (95% CI 49-77%). The pooled sensitivity and specificity were significantly higher on POD 5 than on other PODs (p < 0.001).


CONCLUSIONS
Infectious complications after major abdominal surgery are very unlikely in patients with a CRP below 159 mg/L on POD 3. This can aid patient selection for safe and early hospital discharge and prevent overuse of imaging.
Department of Surgery (G4-133), Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands, s.l.gans@amc.uva.nl.
Sarah L
SL
Gans
Jasper J
JJ
Atema
Susan
S
van Dieren
Bas
B
Groot Koerkamp
Marja A
MA
Boermeester
D000005:Abdomen / Q000601:surgery*; D002097:C-Reactive Protein / Q000378:metabolism*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D011237:Predictive Value of Tests; D017594:Publication Bias
D002097:C-Reactive Protein