title: Predictive value of C-reactive protein in critically ill patients after abdominal surgery.
abstract: The development of sepsis after abdominal surgery is associated with high morbidity and mortality. Due to inflammation, it may be difficult to diagnose infection when it occurs, but measurement of C-reactive protein could facilitate this diagnosis. In the present study, we evaluated the predictive value and time course of C-reactive protein in relation to outcome in patients admitted to the intensive care unit (ICU) after abdominal surgery.
  We included patients admitted to the ICU after abdominal surgery over a period of two years. The patients were divided into two groups according to their outcome: favorable (F; left the ICU alive, without modification of the antibiotic regimen) and unfavorable (D; death in the ICU, surgical revision with or without modification of the antibiotic regimen or just modification of the regimen). We then compared the highest C-reactive protein level on the first day of admission between the two groups.
  A total of 308 patients were included: 86 patients had an unfavorable outcome (group D) and 222 had a favorable outcome (group F). The groups were similar in terms of leukocytosis, neutrophilia, and platelet count. C-reactive protein was significantly higher at admission in group D and was the best predictor of an unfavorable outcome, with a sensitivity of 74% and a specificity of 72% for a threshold of 41 mg/L. No changes in C-reactive protein, as assessed based on the delta C-reactive protein, especially at days 4 and 5, were associated with a poor prognosis.
  A C-reactive protein cut-off of 41 mg/L during the first day of ICU admission after abdominal surgery was a predictor of an adverse outcome. However, no changes in the C-reactive protein concentration, especially by day 4 or 5, could identify patients at risk of death.
authors.affiliation: Université Libre de Bruxelles, Intensive Care, CHU-Charleroi, 6042-Charleroi, Belgium.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sapin
authors.affiliation: Université Libre de Bruxelles, Intensive Care, CHU-Charleroi, 6042-Charleroi, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Biston
authors.affiliation: Université Libre de Bruxelles, Intensive Care, CHU-Charleroi, 6042-Charleroi, Belgium.
authors.forename: Michael
authors.initials: M
authors.lastname: Piagnerelli
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016638:Critical Illness; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018805:Sepsis / Q000097:blood*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein