title: Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery.
abstract: BACKGROUND
  The ratio of C-reactive protein to albumin, as a novel inflammation-based prognostic score, is associated with outcomes in cancer and septic patients. The diagnostic accuracy of the CRP/albumin ratio has not been assessed in colorectal surgery for postoperative complications.
  
  
  METHODS
  A total of 359 patients undergoing major colorectal surgery between 2012 and 2015 were eligible for this study. Uni- and multivariate analyses were performed to identify risk factors for postoperative complications. Receiver operating characteristic curves were developed to examine the cutoff values and diagnostic accuracy of the CRP/albumin ratio and postoperative CRP levels.
  
  
  RESULTS
  Among all the patients, 139 (38.7%) were reported to have postoperative complications. The CRP/albumin ratio was an independent risk factor for complications (OR 4.413; 95% CI 2.463-7.906; P < 0.001), and the cutoff value was 2.2, which had a higher area under the curve compared to CRP on postoperative day 3 (AUC 0.779 vs 0.756). The CRP/albumin ratio also had a higher positive predictive value than CRP levels on postoperative day 3. Patients with CRP/albumin ≥2.2 suffered more postoperative complications (60.8% vs 18.6%, P < 0.001), longer postoperative stays (10 (4-71) vs 7 (3-78) days, P < 0.001), and increased surgical site infections (SSIs) (21.1% vs 4.8%, P < 0.001) than those with CRP/albumin <2.2.
  
  
  CONCLUSIONS
  The ratio of C-reactive protein to albumin could help to identify patients who have a high probability of postoperative complications, and the ratio has higher diagnostic accuracy than C-reactive protein alone for postoperative complications in colorectal surgery.
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Ge
authors.affiliation: Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cao
authors.affiliation: First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Hongkan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Ding
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
authors.forename: Hongliang
authors.initials: H
authors.lastname: Tian
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
authors.forename: Xueying
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China. jinlingh_gongjf@163.com.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Gong
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
authors.forename: Weiming
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China. jinlingh_lining@163.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
mesh_terms: D000418:Albumins / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D015179:Colorectal Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D000418:Albumins; D014408:Biomarkers, Tumor; D002097:C-Reactive Protein
keywords: C-reactive protein to albumin ratio; Colorectal surgery; Diagnoses