C-reactive protein is an early predictor of septic complications after elective colorectal surgery

Abstract

Background: Nowadays, most patients who undergo colorectal surgery are discharged early. An early predictor of septic complications could avoid readmissions and decrease morbidity. CRP could be a good predictor allowing a safe discharge.

Methods: A prospective, observational study was conducted from November 2007 to October 2008. All patients who underwent elective colorectal surgery were included. Clinical (temperature, pulse, abdominal tenderness, bowel movements) and laboratory data (C-reactive protein, leukocyte count) were recorded and evaluated as early predictors of septic complications (namely, anastomotic leaks). All detected leaks were considered fistulas, independently of their clinical significance. Clinical and inflammatory parameters were analyzed with univariate and multivariate techniques; logistic regression was performed and areas under the receiver operating characteristic curve were compared.

Results: A total of 133 patients were included. The overall incidence of anastomotic leaks was 15.5% and mortality was 4.5%. C-reactive protein at postoperative days 2 and 4 was a good predictor of anastomotic leak (areas under the curve were 0.715 and 0.845, respectively) and other postoperative septic complications (areas under the curve were 0.804 and 0.787), showing the highest accuracy among clinical and laboratory data. A cutoff of 125 mg/l in the level of C-reactive protein at postoperative day 4 yielded a sensitivity of 81.8% and a negative predictive value of 95.8% for the detection of anastomotic leakage.

Conclusions: C-reactive protein is a simple way to ensure a safe discharge from hospital after elective colorectal surgery. Patients with CRP values >125 mg/l on the fourth postoperative day should not be discharged.

Keywords: C-reactive protein; anastomotic leak; fistula; inflammatory markers; intra-abdominal infection; postoperative complications.

Figure 1

Kinetics of C-reactive protein on the day before surgery (−1), postoperative day 2, postoperative day 4, postoperative day 6 and postoperative day 9, in patients with and without anastomotic leaks.

Figure 2

Kinetics of white blood cell count on the day before surgery (−1), postoperative day 2, postoperative day 4, postoperative day 6 and postoperative day 9, in patients with and without anastomotic leak.