Role of post‐operative serum C‐reactive protein levels as a predictor of complications in upper gastrointestinal surgery

Späth, Christoph; Srinivasa, Sanket; Walsh, Michael F.; Singh, Pushpendra; Rodgers, Michael; Koea, Jonathan

doi:10.1111/ans.14789

Cited by 7 publications

(4 citation statements)

References 31 publications

(61 reference statements)

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“…It is possible that the effect may be different in minor resections with adequate future liver remnant and major resections with diminished capacity of the liver functional reserve, and further studies are warranted. POD1 CRP has a high negative predictive value for postoperative morbidity, which is consistent with our study[ 32 ].…”

Section: Discussionsupporting

confidence: 93%

Perioperative steroid administration reduces overall complications in patients undergoing liver resection: A meta-analysis

Hai¹,

Aw²,

Teng³

et al. 2021

WJGS

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BACKGROUND Hepatic resection (HR) results in an inflammatory response that can be modified by perioperative steroid administration. However, it remains to be determined if this response's attenuation translates to a reduction in complications. AIM To evaluate if perioperative administration of steroids reduces complications following HR. METHODS A systematic review of randomized controlled trials (RCTs) was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials to evaluate the effect of perioperative steroid (compared to placebo or no intervention) use in patients undergoing HR. Clinical outcomes were extracted, and meta-analysis was performed. RESULTS 8 RCTs including 590 patients were included. Perioperative steroid administration was associated with significant reduction in postoperative complications [odds ratios: 0.58; 95% confidence intervals (CI): 0.35-0.97, P = 0.04]. There was also improvement in biochemical and inflammatory markers, including serum bilirubin on postoperative day 1 [MD: -0.27; 95%CI: (-0.47, -0.06), P = 0.01], C-reactive protein on postoperative day 3 [MD: -4.89; 95%CI: (-5.83, -3.95), P < 0.001], and interleukin-6 on postoperative day 1 [MD: -54.84; 95%CI: (-63.91, -45.76), P < 0.001]. CONCLUSION Perioperative steroids administration in HR may reduce overall complications, postoperative bilirubin, and inflammation. Further studies are needed to determine the optimal dose and duration and patient selection.

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Section: Discussionsupporting

confidence: 93%

Perioperative steroid administration reduces overall complications in patients undergoing liver resection: A meta-analysis

Hai¹,

Aw²,

Teng³

et al. 2021

WJGS

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“…CRP and procalcitonin are biochemical markers of inflammation and infection. CRP is synthesized in hepatocytes following stimulation by pro-inflammatory cytokines and secreted into the blood in response to inflammation and infection [13]. In this study, for CRP, the three groups showed a significant difference as pre-determined.…”

Section: Discussionmentioning

confidence: 59%

The Role of Immature Granulocytes and Inflammatory Hemogram Indices in the Inflammation

İncir¹

2020

Int J Med Biochem

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The role of immature granulocytes and inflammatory hemogram indices in the inflammation I nflammation should be rapidly detected and differentiated to determine the underlying pathology. It is vital to distinguish any infection from other causes of inflammation because of early intervention. If a physician suspects of inflammation or infection after a physical examination, biochemical markers or blood cultures are needed for making a correct diagnosis. As these are time-consuming and not cost-effective, faster and cheaper indicators are required for early intervention [1,2]. In this regard, inflammatory markers, such as C-re-active protein (CRP) and procalcitonin, have been routinely used for the early diagnosis [3]. By the development of new hematology analyzers, the early detection of inflammation has become possible. Recent studies have pointed out that leukocyte count, absolute neutrophil count (ANC) and band count may be an early indicator of inflammation or sepsis [4]. The Sysmex XN-3100 (Sysmex Corporation, Kobe, Japan) enables to detect the percentage of immature granulocytes (IG%) using flow cytometry in the Objectives: In this retrospective study, we aimed to assess the role of immature granulocyte percentage (IG%), inflammatory complete blood count (CBC) parameters and indices in investigating the severity of inflammation, to evaluate their correlation, and to determine their predictive ability in classifying inflammation. Methods: We obtained hematological and biochemical data of the 161 outpatients for this study. Patients were assigned to three groups according to their C-reactive protein (CRP) levels. Group I had a CRp-value of <3 mg/L (non-inflammatory group) (n=58), Group II had a CRP level between 3 to 9mg/L (low-grade inflammatory group) (n=59), and Group III had a CRP level of >9mg/L (clinically significant inflammatory group)(n=44). The between-group differences were evaluated concerning sex, age, CRP, procalcitonin, IG%, CBC parameters and indices, including Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR) and Systemic Immune-Inflammatory Index (SII). Results: In Group II, the levels of CRP (p<0.0001), platelet count (p<0.05), PLR (p<0.05), NLR (p<0.05) and SII (p<0.01) were significantly higher than those in the Group I. In Group III, CRP (p<0.0001), IG% (p<0.0001), procalcitonin (p<0.01), platelet count (p<0.05), PLR (p<0.01), NLR (p<0.05) and SII (p<0.01) values showed a significant between-group difference when compared to Group I. A significant difference between Group II and Group III was detected for, CRP (p<0.0001) and IG% (p<0.05). There were significant positive correlations among IG% and CRP (p<0.001), platelet count (p<005), PLR (p<0.05) and SII (<0.05). The sensitivity and specificity values of the IG% using a cut-off value of >0.2 were 75.3% and 52.5%, respectively. Conclusion:The findings obtained in this study suggest that to detect the severity of inflammation, it would be more reliable to evaluate the combination of CBC parameters with biochemical ma...

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“…Lower levels of these indicators have been shown to reflect lower likelihood of progressing to anastomotic leak (27–30). Studies have also shown that there is a correlation between overall postoperative complication rates and postoperative CRP levels as well (17, 31–33). Therefore, the reduced inflammatory levels in the acellular dermal matrix reinforcement group of this study may suggest that the anastomotic site reinforcement makes the operation more tolerable for the patient and has the potential to decrease likelihood of anastomotic leak development.…”

Section: Discussionmentioning

confidence: 97%

Effect of Biologic Material Reinforcement on Surgical Anastomosis After Gastrectomy—A Pilot Study

Kim

Lee

et al. 2019

Front. Oncol.

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Background: Acellular dermal matrix is a biologic material derived from the skin of human cadaveric donors. It has been used successfully in the past to reduce complications in breast surgery and hernia repair. This investigation was aimed at assessing the feasibility of using acellular dermal matrix to support the anastomosis after gastrectomy with the aim of reducing anastomotic site leakage complications.Methods: Patients were randomly assigned to standard anastomotic reconstruction (control arm) or anastomotic reconstruction with acellular dermal matrix reinforcement (intervention arm). Surgical outcomes related to anastomotic complications were collected. Because actual anastomotic leaks found on imaging studies are infrequent and thus require a very high number of patient recruitment to detect statistically significant difference between the two groups, in this pilot investigation other clinical and laboratory measures that have been shown to correlate to or predict anastomotic leaks were also collected. Each surgical outcome was compared.Results: A total of 94 patients (intervention arm: 50, control arm: 44), were included in the analysis. Two patients in the control arm (4.55%) and one patient in the intervention arm (2.00%) experienced anastomotic leakage (p = 0.598), a difference without statistical significance. However, average postoperative C-reactive protein (CRP) levels and NUn scores, both of which have been shown to reflect likelihood of progressing to anastomotic leakage, were significantly lower for the intervention arm. The control arm showed an average CRP level of 128.77 mg/dL (SD: 97.08) while the intervention arm showed 77.38 mg/dL (SD: 49.08, p = 0.049).Conclusions: Leakage rate reduction with acellular dermal matrix reinforcement of anastomotic site was not detected in this investigation. However, postoperative inflammation levels and numerical predictors of anastomotic leakage development were significantly lower with acellular dermal matrix reinforcement of surgical anastomosis. This finding is worthy of further investigation, as reduction of inflammation with anastomotic site reinforcement is a novel finding, and more in-depth research may lead to discoveries on the physiologic role of the surgical anastomosis in post-gastrectomy patients. In addition, lower CRP and NUn scores for the intervention arm suggest potential for larger studies to detect reduction in clinical leak rates after acellular dermal matrix reinforcement.

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Role of post‐operative serum C‐reactive protein levels as a predictor of complications in upper gastrointestinal surgery

Abstract: CRP measurements can be used as a negative predictive marker of infective complications in the first post-operative week after major elective upper gastrointestinal surgery.

Cited by 7 publications

References 31 publications

Perioperative steroid administration reduces overall complications in patients undergoing liver resection: A meta-analysis

Perioperative steroid administration reduces overall complications in patients undergoing liver resection: A meta-analysis

The Role of Immature Granulocytes and Inflammatory Hemogram Indices in the Inflammation

Effect of Biologic Material Reinforcement on Surgical Anastomosis After Gastrectomy—A Pilot Study

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