Role of C-Reactive Protein Assessment as Early Predictor of Surgical Site Infections Development after Pancreaticoduodenectomy

Abstract

Background: Surgical site infections (SSIs) are extremely common in pancreatic surgery and explain its considerable morbidity and mortality, even in tertiary centers. Early detection of these complications, with the help of laboratory assays, improve clinical outcome. The aim of the present study is to evaluate C-reactive protein (CRP) diagnostic accuracy as early predictor of SSIs after pancreaticoduodenectomy (PD). Methodology: We considered 251 consecutive PD. We prospectively recorded preoperative clinical and anthropometric data, intraoperative details and the postoperative outcome. In the first pool of consecutive patients (n = 150), we analyzed CRP levels from postoperative day 1 to 7 and investigated the prediction of SSIs. We then validated the diagnostic accuracy on the following 101 consecutive cases. Results: At multivariate analysis, high BMI and preoperative biliary stenting appeared to be independently associated with SSIs and organ-space SSI development. The CRP cutoff of 17.27 mg/dl on postoperative day 3 (78% sensitivity, 79% specificity) and of 14.72 mg/dl on postoperative day 4 (87% sensitivity, 82% specificity) was in a position to predict the course of 78.2 and 80.2% of patients, respectively. Conclusions: CRP on postoperative days 3 and 4 seems able to predict postoperative course, selecting patients deserving intensification of diagnostic assessment; patients not satisfying these conditions could be reasonably directed toward early discharge.

Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery

“…Increasing evidence shows that a systemic inflammatory response following surgical trauma is associated with poor outcome in patients after surgery, and this was revealed by serum C-reactive protein and albumin [9, 16, 17]. There are some inflammation-based prognostic scores, such as the modified Glasgow Prognostic Score (mGPS), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), postoperative Glasgow Prognostic Score (poGPS), and CRP to albumin ratio (CAR), that predict outcomes for surgical patients [15, 18–20].…”

Maximizing Interpretability and Cost-Effectiveness of Surgical Site Infection (SSI) Predictive Models Using Feature-Specific Regularized Logistic Regression on Preoperative Temporal Data

“…Several researchers have already focused on predicting SSI based on electronic health records (EHRs), for example, by using patient demographics, past medical history, and surgical information [15]. In recent studies, ranging from model evaluation methods, such as ROC analysis [16, 17], to data-driven modelling approaches, such as linear regression models [1, 18, 19] and Support Vector Machines [20], the attention has shifted to results of blood tests before and after surgery. One of the main reasons being the ease and extent of this type of data.…”

“…Several studies have taken a classical (knowledge-based) approach and handcrafted features by setting cutoff values of CRP after the surgery, where the term of postoperative day (POD) is commonly used. For example, Angiolini et al [19] evaluated the diagnostic accuracy as an early predictor of SSIs after pancreaticoduodenectomy and showed that CRP on POD 3, with a cutoff of 17.27 mg/dl, predicted the postoperative course in 78.2% of patients, whereas a CRP cutoff of 14.72 mg/dl on POD 4 predicted the postoperative course in 80.2% of patients. A systematic review of studies on diagnostic value of CRP after major abdominal surgery for predicting SSI [21] showed that CRP > 15.9 mg/dl on POD 3 increases the risk of SSI [10].…”

¿Son útiles la proteína C reactiva y la procalcitonina para el diagnóstico precoz de la infección intraabdominal después de una duodenopancreatectomía por cáncer de páncreas?

“…El diagnóstico precoz de estas complicaciones es importante para poder instaurar el tratamiento apropiado y disminuir la mortalidad. La proteína C reactiva (PCR) se ha considerado como un marcador válido para la detección de complicaciones inflamatorias posoperatorias en cirugía pancreática [3][4][5][6][7] ; sin embargo, la procalcitonina (PCT), que es un marcador más válido para la detección de infección 8 , no ha sido muy investigada en pacientes con cirugía pancreática y solo hay unos pocos artículos en los que se analice su utilidad en este sentido. Planteamos este estudio con el fin de analizar la relación entre los valores de PCR y PCT, en los primeros días de posoperatorio, y la aparición de infección intraabdominal posoperatoria (IIAP) después de una DPC en pacientes con cáncer de páncreas.…”