Retrospective study to evaluate the clinical significance of a second rise in C-reactive protein level following instrumented spinal fusion surgery

Fujita, Ryo; Takahata, Masahiko; Kokabu, Terufumi; Oda, Ichiro; Kajino, Tomomichi; Hisada, Yuichiro; Takeuchi, Hirohito; Iwasaki, Norimasa

doi:10.1016/j.jos.2019.09.002

Cited by 11 publications

(9 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CRP levels change in the presence of infections, with high levels decreasing the success of surgical procedures. A common finding of studies in literature is that elevated CRP levels are associated with negative outcomes in various surgical procedures and medical therapies [15,16]. In the present study, CRP was higher in Group 2 than in Group 1.…”

Section: Discussionsupporting

confidence: 52%

The effect of preprocedural serum albumin to fibrinogen ratio on arteriovenous fistula maturation

Akgül¹,

Özhan²

2021

Journal of Surgery and Medicine

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 52%

The effect of preprocedural serum albumin to fibrinogen ratio on arteriovenous fistula maturation

Akgül¹,

Özhan²

2021

Journal of Surgery and Medicine

View full text Add to dashboard Cite

“…Current research is focused on the behavior of serum biomarkers in the early postoperative period [ 17 ], where the white blood cell count, CRP, ESR, serum amyloid A, and PCT have been established as the conventional biomarkers [ 24 ]. Research for these biomarkers, as well as other new ones, relies primarily on retrospective cohorts on a single-measurement basis [ 11 , 22 , 28 - 32 ] with few prospective studies performed up to date [ 17 , 24 , 29 ], representing a significant limitation in the validity of results. Although several biomarkers exist in current research, they are studied individually [ 17 ] for a heterogenous group of illnesses in the spectrum of spinal infection with patients undergoing different surgical procedures [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although no clear cutoff values can be drawn from the conclusion of the research and there exist contrasting evidence, it seems that CRP rises in the second and third postoperative day of noninfected patients, lowering its concentrations thereafter; this rise is dependent on the extent of surgery, but the behavior is similar for both of them [ 34 ]. As a result, secondary rises [ 32 ] or persistently high CRP serum concentrations beyond this period are suspicious of PSI, specifically after postoperative day 7 [ 35 , 36 ]. Nevertheless, these findings can derive from other noninfectious conditions in the postoperative period or have no obvious explanation [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…As a result, secondary rises [ 32 ] or persistently high CRP serum concentrations beyond this period are suspicious of PSI, specifically after postoperative day 7 [ 35 , 36 ]. Nevertheless, these findings can derive from other noninfectious conditions in the postoperative period or have no obvious explanation [ 32 ]. Provided that CPR is most sensitive but not that specific (100% and 91.7%), other biomarkers such as PCT have demonstrated remarkable usefulness in differentiating inflammatory response as a result of surgery from that of spinal infection (100% specificity and 95.2% specificity) [ 37 ] provided that PCT does not seem to be affected because of the extent of surgery and rises in the first postoperative day remaining steadily low there forward [ 37 ]; unfortunately, it does not differentiate infection in other anatomical regions and there also exists evidence reporting no difference in PCT concentration among patients with and without postoperatory spinal infections [ 38 ], adding to the lack of a clear cutoff value to consider infection.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Inflammatory Biomarkers Behavior Profile of Patients Following Elective Degenerative Spine Surgery and Differences Compared to Those Coursing With a Postoperative Spinal Infection: Protocol for a Systematic Review

Rangel¹,

Ponce²,

Chew³

et al. 2023

JMIR Res Protoc

View full text Add to dashboard Cite

Background The incidence of postoperative spinal infection (PSI) ranges from 0% to 10%, with devastating effects on the patient prognosis because of higher morbidity while increasing costs to the health care system. PSIs are elusive and difficult to diagnose, especially in the early postoperative state, because of confusing clinical symptoms, rise in serum biomarkers, or imaging studies. Current research on diagnosis has focused on serum biomarkers; nevertheless, most series rely on retrospective cohorts where biomarkers are studied individually and at different time points. Objective This paper presents the protocol for a systematic review that aims to determine the inflammatory biomarker behavior profile of patients following elective degenerative spine surgery and their differences compared to those coursing with PSIs. Methods The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. This protocol was registered at PROSPERO on January 19, 2022. We will include studies related to biomarkers in adult patients operated on for degenerative spinal diseases and those developing PSIs. The following information will be extracted from the papers: (1) study title; (2) study author; (3) year; (4) evidence level; (5) research type; (6) diagnosis group (elective postoperative degenerative disease or PSI); (7a) region (cervical, thoracic, lumbosacral, and coccygeal); (7b) type of infection by anatomical or radiological site; (8) surgery type (including instrumentation or not); (9) number of cases; (10) mean age or individual age; (11) individual serum biomarker values from the preoperative state up to 90 days postoperative for both groups, including (10a) interleukin-6, (10b) presepsin, (10c) erythrocyte sedimentation rate, (10d) leukocyte count, (10e) neutrophil count, (10f) C-reactive protein, (10g) serum amyloid, (10h) white cell count, (10i) albumin, (10j) prealbumin, (10k) procalcitonin, (10l) retinol-associated protein, and (10m) Dickkopf-1; (11) postoperative days at symptoms or diagnosis; (12) type of organism; (13) day of starting antibiotics; (14) duration of treatment; and (15) any biases (including comorbidities, especially those affecting immunological status). All data on biomarkers will be presented graphically over time. Results No ethical approval will be required, as this review is based on published data and does not involve interaction with human participants. The search for this systematic review commenced in February 2021, and we expect to publish the findings in mid-2023. Conclusions This study will provide the behavior profile of biomarkers for PSI and patients following elective surgery for degenerative spinal diseases from the preoperative period up to 90 days postoperative, providing cutoff values on the day of diagnosis. This research will provide clinicians with highly trustable cutoff reference values for PSI diagnosis. Finally, we expect to provide a basis for future research on biomarkers that help diagnose more accurately and in a timely manner in the early stages of illness, ultimately impacting the patient’s physical and mental health, and reducing the disease burden. Trial Registration PROSPERO CRD42022304645; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304645 International Registered Report Identifier (IRRID) DERR1-10.2196/41555

show abstract

“…Therefore, early detection of SSI is important for the development of a surgical strategy. However, it is challenging in that clinical examination for SSI is vague and ambiguous due to the incubation period and is dependent on the patients' expression [16] . Therefore, many surgeon has tried to find objective and reliable methods such as laboratory tests to diagnose SSI, but there are still controversy [17] .…”

Section: Discussionmentioning

confidence: 99%

A reliable diagnostic method of surgical site infection after posterior lumbar surgery based on serial C-reactive protein

Kim

Park

Kim

2021

International Journal of Surgery: Global Health

View full text Add to dashboard Cite

Study design: A observational study. Purpose: To evaluate the detection of surgical site infection (SSI) after posterior lumbar surgery by the laboratory parameters. Materials and methods: The study included 189 patients undergoing posterior lumbar fusion or decompression between January 2018 and December 2019. Patients with chronic renal disease, rheumatoid arthritis, hepatic disease were excluded. Patients with tumor, trauma, cervical and thoracic lesions were also excluded. Leukocyte counts, segmented neutrophils, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were evaluated preoperatively and on postoperative days 1 (POD1), 3 (POD3), 7 (POD7), 14 (POD14), and 30 (POD30). Surgical site infection was defined as (1) purulent discharge at incision site, (2) organisms isolated aseptically from the incision site, and (3) evidence of infection based on MRI. Increasing CRP (ICRP) and decreasing CRP (DCRP) groups were classified according to the value of CRP on POD7. The change rate in CRP was calculated using the formula: (Late value−Previous value/Previous value)×100. Receiver operating characteristic curves were used to validate laboratory data involving SSI. Results: The mean age was 64.5±12.5 years. Male to female ratio was 91–98. The incidence of SSI was 8.8%. Leukocyte count, segmented neutrophil, and ESR were not specific. ICRP group were 43 patients. SSI was found in 14% of ICRP group and 18.6% was associated with secondary infection. Even 7.7% of the infection in DCRP group was identified as SSI. Based on the change rate of CRP, −50% of decreasing rate of CRP in ICRP group between POD7 and POD14 showed the validity that sensitivity was 90.9% and specificity was 68.1%. In DCRP group, −43.3% of decreasing rate of CRP in DCRP group between POD7 and POD14 showed the validity that sensitivity and specificity were 83.3% and 82.4%, respectively. Only 43% of all patients showed normalization of CRP can rule out the SSI. Conclusion: The serial change rate of CRP is a reliable method for detecting SSI more than the criteria of normal value. Nevertheless, close monitoring of patient’s signs and symptoms is important to detect early SSI.

show abstract

Retrospective study to evaluate the clinical significance of a second rise in C-reactive protein level following instrumented spinal fusion surgery

Cited by 11 publications

References 26 publications

The effect of preprocedural serum albumin to fibrinogen ratio on arteriovenous fistula maturation

The effect of preprocedural serum albumin to fibrinogen ratio on arteriovenous fistula maturation

The Inflammatory Biomarkers Behavior Profile of Patients Following Elective Degenerative Spine Surgery and Differences Compared to Those Coursing With a Postoperative Spinal Infection: Protocol for a Systematic Review

A reliable diagnostic method of surgical site infection after posterior lumbar surgery based on serial C-reactive protein

Contact Info

Product

Resources

About