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. 2024 Nov 7;84(11):1066-1073.
doi: 10.1055/a-2413-5449. eCollection 2024 Nov.

Retrospective Evaluation of C-reactive Protein for Ruling Out Infection After Cesarean Section

Sabine Enengl  1 , Peter Oppelt  1 , Richard Bernhard Mayer  2 , Elisabeth Brandlmayr  1 , Philip Sebastian Trautner  1
Affiliations

Retrospective Evaluation of C-reactive Protein for Ruling Out Infection After Cesarean Section

Sabine Enengl et al. Geburtshilfe Frauenheilkd. .

Abstract
in English, German

Introduction: Infection after cesarean section is a major contributor to maternal morbidity. Measurement of C-reactive protein (CRP) is a laboratory test frequently conducted to rule out or confirm postoperative infection. The present study aimed to evaluate whether CRP is a suitable tool for ruling out infection after cesarean section and whether there are any reliable cut-off values.

Materials and methods: 2056 patients with cesarean section (CS) over a 3-year period were included in a retrospective analysis. Outcome parameters and risk factors for postoperative infection were collected. CRP values from preoperative and postoperative tests were compared. Cut-offs for ruling out infection were assessed.

Results: Among 2056 CSs, postoperative infection occurred in 78 cases (3.8%). The prevalence of infection in emergency CS was lowest, at four out of 134 (2.9%), and the highest prevalence was seen in secondary CS, at 42 of 903 (4.6%; p = 0.35). CRP values in the infection group were significantly higher (preoperative, 1.01 mg/dl vs. 0.62 mg/dl; day 1 postoperative, 7.91 mg/dl vs. 6.44 mg/dl; day 4 postoperative, 8.44 mg/dl vs. 4.09 mg/dl; p = 0.01). A suitable cut-off value for ruling out infection was not identified.

Conclusions: Although CRP values were significantly higher in the infection group, the clinical relevance of this appears to be negligible. CRP testing does not appear to be a reliable tool for diagnosing or ruling out postoperative infection.

Einleitung: Infektionen nach einer Kaiserschnittentbindung tragen wesentlich zur mütterlichen Morbidität bei. Die Messung von C-reaktivem Protein (CRP) ist ein häufig durchgeführter Labortest, um postoperative Infektionen auszuschließen oder zu bestätigen. Ziel dieser Studie war es, herauszufinden, ob CRP ein geeignetes Instrument zum Ausschließen von Infektionen nach einer Kaiserschnittentbindung sein könnte, und ob es verlässliche Cut-off-Werte dafür gibt.

Material und methoden: Es wurden 2056 mit Kaiserschnitt entbundene Patientinnen über einen Zeitraum von 3 Jahren in die retrospektive Analyse aufgenommen. Outcome-Parameter und Risikofaktoren für eine postoperative Infektion wurden gesammelt. Die CRP-Werte der prä- und postoperativen Tests wurden verglichen. Es wurden Cut-off-Werte für den Ausschluss einer Infektion bewertet.

Ergebnisse: Bei 2056 mit Kaiserschnitt entbundenen Frauen gab es in 78 Fällen (3,8%) eine postoperative Infektion. Die Infektionsprävalenz war beim Notfallkaiserschnitt am niedrigsten mit insgesamt 4 Fällen von 134 Patientinnen (2,9%). Die höchste Prävalenz fand sich bei sekundären Kaiserschnittentbindungen mit 42 aus 903 Fällen (4,6%; p = 0,35). Die CRP-Werte der Infektionsgruppe waren signifikant höher (präoperative Werte: 1,01 mg/dl vs. 0,62 mg/dl; 1. postoperativer Tag: 7,91 mg/dl vs. 6,44 mg/dl; 4. postoperativer Tag: 8,44 mg/dl vs. 4,09 mg/dl; p = 0,01). Es ließ sich aber kein geeigneter Wert identifizieren, der verlässlich Infektionen ausschloss.

Schlussfolgerungen: Obwohl die CRP-Werte in der Infektionsgruppe signifikant höher waren, scheint dessen klinische Relevanz vernachlässigbar. CRP-Tests stellen kein verlässliches Instrument für die Diagnose oder den Ausschluss von postoperativen Infektionen dar.

Keywords: C-reactive protein; CRP; cesarean section; infection; surgical site infection.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Receiver operating characteristic (ROC) curve analysis of C-reactive protein values: postoperative day 1. A cut-off value of 6.7 mg/dl for predicting early infection was calculated (sensitivity 68%, specificity 60.87%).
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve analysis of C-reactive protein values: postoperative day 4. A cut-off value of 7.3 mg/dl for predicting late infection was calculated (sensitivity 34.78%, specificity 91.81%).
See this image and copyright information in PMC

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