A threshold for concern? C-reactive protein levels following operatively managed neck of femur fractures can detect infectious complications with a simple formula

Chapman, George; Holton, James R.; Chapman, Andrew

doi:10.1016/j.clinbiochem.2015.10.018

Cited by 19 publications

(14 citation statements)

References 17 publications

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“…C-reactive protein (CRP) is an indicator of inflammatory processes and its levels rise in response to surgical procedures or infection. Therefore, it is commonly used as an index of complications after surgery [3–7]. A study that investigated the association between changes in serum proinflammatory and anti-inflammatory cytokine concentrations and postoperative septic complications reported that the postoperative increase in interleukin (IL)-6 concentration was associated with septic morbidity, while an elevated level of the IL-1 receptor antagonist (IL-1ra) was associated with postoperative septic shock [8].…”

Section: Introductionmentioning

confidence: 99%

Anti-inflammatory and immune regulatory effects of acupuncture after craniotomy: study protocol for a parallel-group randomized controlled trial

Cho

Yang

Shin

et al. 2017

Trials

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BackgroundDespite recent advances in the medical and surgical fields, complications such as infection, pneumonia, or brain swelling may occur after a craniotomy. In some patients, perioperative antibiotic prophylaxis causes adverse effects such as itching, rash, or digestive conditions. Certain patients still develop infections severe enough to require a repeat operation despite antibiotic prophylaxis. Acupuncture has been used to treat inflammatory conditions, and many basic and clinical studies have provided evidence of its anti-inflammatory and immune regulatory effects. The aim of this study is to explore the effects of acupuncture on inflammation and immune function after craniotomy.MethodsThis trial will be a single-center, parallel-group clinical trial. Forty patients who underwent craniotomy for an unruptured aneurysm, facial spasm, or a brain tumor will be allocated to either the study or the control group. The study group will receive conventional management as well as acupuncture, electroacupuncture, and intradermal acupuncture, which will start within 48 h of the craniotomy. The patients will receive a total of six sessions within 8 days. The control group will only receive conventional management. The primary outcome measure will be the C-reactive protein levels, while the secondary outcomes will be the serum erythrocyte sedimentation rate and the tumor necrosis factor-α, interleukin (IL)-1β, and IL-6 levels measured at four different time points: within 48 h prior to the craniotomy and on days 2, 4, and 7 after surgery. The presence of fever and infection, the use of additional antibiotics, the presence of infection, including pneumonia or urinary tract infection, and safety will also be investigated.DiscussionIn this trial, we will observe whether acupuncture has anti-inflammatory and immune regulatory effects after a craniotomy. If our study yields positive results and a placebo-controlled study also finds favorable results following our study, acupuncture could be recommended as an adjunctive therapy after a craniotomy.Trial registrationClinicalTrials.gov: NCT02761096. Registered on 27 April 2016. Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1712-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Anti-inflammatory and immune regulatory effects of acupuncture after craniotomy: study protocol for a parallel-group randomized controlled trial

Cho

Yang

Shin

et al. 2017

Trials

View full text Add to dashboard Cite

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“…Cerveró-Ferragut et al reported that proliferative and inflammatory phases had an average CRP level equal to 90 mg/L, which dropped to 5.2 mg/L in the maturation phase [ 131 ]. An average CRP level of about 66 mg/L was reported for trauma-related chronic wounds [ 132 ], whereas wound infections following surgically managed fractures were associated with a CRP concentration of 141 mg/L [ 133 ]. In diabetic foot ulcers, a CRP concentration threshold of 17 mg/L can be used to distinguish between grade 1 (uninfected) and grade 2 (mild severity infection) ulcers [ 134 ], while in venous ulcers the infection threshold was set to 20 mg/L [ 135 ].…”

Section: Discussionmentioning

confidence: 99%

Sensors and Biosensors for C-Reactive Protein, Temperature and pH, and Their Applications for Monitoring Wound Healing: A Review

Salvo

Dini

Kirchhain

et al. 2017

Sensors

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Wound assessment is usually performed in hospitals or specialized labs. However, since patients spend most of their time at home, a remote real time wound monitoring would help providing a better care and improving the healing rate. This review describes the advances in sensors and biosensors for monitoring the concentration of C-reactive protein (CRP), temperature and pH in wounds. These three parameters can be used as qualitative biomarkers to assess the wound status and the effectiveness of therapy. CRP biosensors can be classified in: (a) field effect transistors, (b) optical immunosensors based on surface plasmon resonance, total internal reflection, fluorescence and chemiluminescence, (c) electrochemical sensors based on potentiometry, amperometry, and electrochemical impedance, and (d) piezoresistive sensors, such as quartz crystal microbalances and microcantilevers. The last section reports the most recent developments for wearable non-invasive temperature and pH sensors suitable for wound monitoring.

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“…Chapman et al . [ 20 ] following operatively managed neck of femur fractures suggested that CRP value in excess of the threshold-defined level, by the formula 500/day postoperatively, might indicate the presence of a postoperative infection.…”

Section: Discussionmentioning

confidence: 99%

“…In their study, they recommended that CRP concentrations above 96 mg/L after the 4 th postoperative day might aid in early detection of surgical complications with a sensitivity of 92% and a specificity of 93%. Chapman et al [20] following operatively managed neck of femur fractures suggested that CRP value in excess of the threshold-defined level, by the formula 500/day postoperatively, might indicate the presence of a postoperative infection.…”

Section: Discussionmentioning

confidence: 99%

Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?

et al. 2017

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Background:Infection is a common serious complication postpediatric cardiac surgery. Diagnosis of infection after cardiopulmonary bypass (CPB) is difficult in the presence of surgical stress, hemodynamic instability, and inflammatory reaction.Aim:The purpose of this study is to investigate the value of available inflammatory biomarkers and its validity to differentiate infection from inflammation postpediatric cardiac surgery and to find the trend and the change in the level of these biomarkers shortly after cardiac surgery.Methods:We conducted a prospective study that included all children who underwent cardiac surgery in Prince Sultan Cardiac Centre-Qassim from November 2013 to October 2015. C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and neutrophil count were measured for all patients presurgery, 4 consecutive days postsurgery, and predischarge. Patients were divided into two groups (the infected and the noninfected group). We compared the level of biomarkers between both groups. Then, we further analyzed the effects of CPB and preoperative steroid on postoperative inflammatory biomarker levels. Collected data were then reviewed and analyzed.Results:There were 134 pediatric cardiac patients included during the study period. Group 1 (bacterial negative culture group) had 125 cases and Group 2 (bacterial positive culture group) had nine cases. We found no statistically significant difference in inflammatory biomarker elevation between both groups. Only Group 2 had higher (RACHS) Risk adjustment for congenital heart surgery score, more ventilator days, and more drop in platelet count on the 2nd and 3rd postoperative days in comparison with the noninfected group 1. Both groups of patients who were in on and off CPB had the same level of inflammatory biomarkers with no significant differences. Giving corticosteroid preoperatively did not affect the trend of biomarker elevation and made no difference when it was compared to the group of patients who did not receive corticosteroid before surgery.Conclusion:Common inflammatory biomarkers cannot differentiate between infection and inflammation within the first 5 days postpediatric cardiac surgery as these reflect the inflammatory process rather than infection. Trend is more important than single reading.

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A threshold for concern? C-reactive protein levels following operatively managed neck of femur fractures can detect infectious complications with a simple formula

Cited by 19 publications

References 17 publications

Anti-inflammatory and immune regulatory effects of acupuncture after craniotomy: study protocol for a parallel-group randomized controlled trial

Anti-inflammatory and immune regulatory effects of acupuncture after craniotomy: study protocol for a parallel-group randomized controlled trial

Sensors and Biosensors for C-Reactive Protein, Temperature and pH, and Their Applications for Monitoring Wound Healing: A Review

Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?

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