Postoperative C-reactive protein as a predictive marker for surgical site infection after cesarean section: Retrospective analysis of 748 patients at a Japanese academic institution

Abstract

Surgical site infection (SSI) is a common but potentially serious maternal complication of cesarean section (CS). C-reactive protein (CRP) can be used in early detection of SSI. However, its predictive value for post-cesarean SSI has never been investigated. This study aims to evaluate the predictive value of CRP for the development of SSI. This was a hospital-based retrospective cohort study of 748 pregnant women who underwent CS at our university hospital between January 2017 and December 2019. CRP was measured on postoperative days 1, 3, and 6. The predictive values of CRP for SSI were evaluated using receiver operating characteristics analysis. Forty-seven (6.3%) patients developed SSI, of whom 38 (80.9%) underwent emergency CS. Serum CRP levels were significantly higher in the SSI group than in the non-SSI group from postoperative day 1 (64 vs. 81 mg/L, p = 0.001); the difference became more evident on postoperative days 3 and 6. The area under the receiver operating characteristic curve (AUC) for CRP on days 1, 3, and 6 was 0.58 (95% confidence interval [CI], 0.49 to 0.68), 0.70 (0.62 to 0.78) and 0.73 (0.65 to 0.81), respectively. The optimal cutoff value for day 3 and 6 CRP was 66.4 mg/L (sensitivity = 76.1% and specificity = 54.4%) and 22.2 mg/L (sensitivity = 76.5% and specificity = 63.2%), respectively. CRP on postoperative days 3 and 6 can be used as a predictive marker for the development of SSI after CS. Further studies to validate the predictive value in different populations is essential.

Risk of major birth defects after first‐trimester exposure to carbocisteine and ambroxol: A multicenter prospective cohort study using counseling data for drug safety during pregnancy

“…To collect data on pregnancy outcomes, a questionnaire was sent to the participants 1 month after their expected date of delivery. The questionnaire included the following items: pregnancy outcome (live birth, stillbirth, artificial abortion, and miscarriage); date and method of delivery; and infant demographic information at 1 month regarding any health‐related issues identified by a pediatrician between birth and the 1‐month checkups 14 . The questionnaire was completed by the participants, and physicians reviewed the questionnaire responses and contacted participants if their responses were missing or incomplete.…”

Comparison between extraperitoneal and transperitoneal cesarean section: Retrospective case-control study

“…If the patient had a Tax level > 38 °C, Leu level of 13.5, and CRP level > 60 on the second and third day after surgery, the patient was counted as a patient with a postoperative SSI infection. Miyazaki et al [22] assigned the cut-off at 66.4 mg/L for 76 % CRP sensitivity and 63 % specificity. Mertens et al [23] describes the limited value of CRP in predicting SSI.…”

“…To include infections and exclude CRP values with low sensibility and sensitivity, the cut-off for CRP on the third day was 60 mg/L. The same value was used by Myjazaki et al [22]. In the work of the Rosene et al [24], the inclusion criteria for infection are Tax > 38 + 0.5 °C and Leu 13.7 + 3.…”