title: Predictive Value of C-Reactive Protein for Major Complications after Major Abdominal Surgery: A Systematic Review and Pooled-Analysis.
abstract: BACKGROUND
  Early diagnosis and treatment of complications after major abdominal surgery can decrease associated morbidity and mortality. Postoperative CRP levels have shown a strong correlation with complications. Aim of this systematic review and pooled-analysis was to assess postoperative values of CRP as a marker for major complications and construct a prediction model.
  
  
  METHODS
  A systematic review was performed for CRP levels as a predictor for complications after major abdominal surgery (MAS). Raw data was obtained from seven studies, including 1427 patients. A logit regression model assessed the probability of major complications as a function of CRP levels on the third postoperative day. Two practical cut-offs are proposed: an optimal cut-off for safe discharge in a fast track protocol and another for early identification of patients with increased risk for major complications.
  
  
  RESULTS
  A prediction model was calculated for major complications as a function of CRP levels on the third postoperative day. Based on the model several cut-offs for CRP are proposed. For instance, a two cut-off system may be applied, consisting of a safe discharge criterion with CRP levels below 75 mg/L, with a negative predictive value of 97.2%. A second cut-off is set at 215 mg/L (probability 20%) and serves as a predictor of complications, indicating additional CT-scan imaging.
  
  
  CONCLUSIONS
  The present study provides insight in the interpretation of CRP levels after major abdominal surgery, proposing a prediction model for major complications as a function of CRP on postoperative day 3. Cut-offs for CRP may be implemented for safe early-discharge in a fast-track protocol and, secondly as a threshold for additional examinations, such as CT-scan imaging, even in absence of clinical signs, to confirm or exclude major complications. The prediction model allows for setting a cut-off at the discretion of individual surgeons or surgical departments.
authors.affiliation: Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Straatman
authors.affiliation: Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Annelieke M K
authors.initials: AM
authors.lastname: Harmsen
authors.affiliation: Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Cuesta
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.affiliation: Medical Library, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Elise P
authors.initials: EP
authors.lastname: Jansma
authors.affiliation: Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Donald L
authors.initials: DL
authors.lastname: van der Peet
mesh_terms: D000005:Abdomen / Q000473:pathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D006801:Humans; D010351:Patient Discharge; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012044:Regression Analysis
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein