Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study

Abstract

Background Postoperative serum concentration of C-reactive protein (CRP) is one of the objective quantitative indices integrating the effects of preoperative and intraoperative variables. Higher levels of CRP after gastrointestinal surgery are associated with major postoperative complications. To develop a model for predicting CRP levels on postoperative day (POD) 1 in surgical patients both with and without serious conditions and comorbidities, we modified the previous formula for prediction of CRP levels on POD1, and assessed the accuracy of our modified predictive formula for CRP levels. Material and methods Consecutive patients of all ages undergoing gastrointestinal surgery under general anesthesia were enrolled in this single-institution prospective cohort study. We developed a modified predictive formula in a calculation cohort. Next, associations between measured CRP levels on POD1, predicted CRP levels on POD1 using the previous and modified models, and major complications after surgery were examined in a validation cohort. Results We obtained the following model in the calculation cohort (n = 222): Modified model for predicting CRP levels on POD1 (mg•dL-1) =-10.13 + 0.0025 Duration of surgery (min) + 15.9 Mean Nociceptive Response (NR) + 0.66 Preoperative CRP level (mg•dL-1). In the validation cohort (n = 440), there was a significant association between measured and predicted CRP levels on POD1 (P < 0.001) No significant difference between the measured and predicted CRP levels using the modified model was observed (P = 0.847). There were also significant associations between the predicted CRP levels and major complications after surgery.

Intra-operative nociceptive responses and postoperative major complications after gastrointestinal surgery under general anaesthesia

“…Postoperative CRP data were missing in 32 of these remaining patients (4%) and data imputation was used to replace them with predicted CRP values. 20 ROC curve analysis revealed that the mean nociceptive response index was significantly associated with major complications after gastrointestinal surgery. Area under the curve (AUC) was 0.705 (95% CI, 0.651 to 0.754), and the cut-off value for the mean nociceptive response index for major complications was 0.83 (P < 0.001), with a sensitivity was 0.693 and specificity of 0.632 (Fig.…”

“…As missing mean nociceptive response index data or postoperative complications only occurred 18 of the 807 patients (2.2%), these 18 patients were excluded, leaving 789 patients in the study. Postoperative CRP data were missing in 32 of these remaining patients (4%) and data imputation was used to replace them with predicted CRP values 20 …”

“…An imputation technique was applied to replace missing data for CRP on POD1 with predicted CRP levels using the following equation: CRP on POD1 (mg dl −1 .) = −10.13 + 0.0025 duration of surgery (min) + 15.9 mean nociceptive response index + 0.66 pre-operative CRP level (mg dl −1 ) 19,20 …”

“…¼ À10.13 þ 0.0025 duration of surgery (min) þ 15.9 mean nociceptive response index þ 0.66 pre-operative CRP level (mg dl À1 ). 19,20 Nociceptive response and major complications 1217 Univariate and multivariate logistic regression analyses were used to find correlations between the mean nociceptive response index and major complications. To exclude the confounding effects of peri-operative variables, we selected age, sex, BMI and pre-operative comorbidities with surgical procedure risks as determined by ASA-PS, emergency surgery and S-MPM, in addition to postoperative CRP levels, as candidate variables for univariate analysis.…”

Intraoperative Assessment of Surgical Stress Response Using Nociception Monitor under General Anesthesia and Postoperative Complications: A Narrative Review

“…Within these proteins, peak blood concentrations of IL-6 and CRP after surgery are associated with the invasiveness of surgical stress [ 55 ]. In a previous study, averaged NR values during surgery were reportedly associated with CRP levels after gastrointestinal surgery ( Table 1 ) [ 43 ]. In addition, associations have been identified between inflammatory and autonomic responses [ 56 , 57 , 58 ].…”