C-reactive Protein as a Predictor of Postoperative Infective Complications after Curative Resection in Patients with Colorectal Cancer

• Published in: Annals of surgical oncology Vol. 19; no. 13; pp. 4168 - 4177
• Main Authors: Platt, Jonathan J., Ramanathan, Michelle L., Crosbie, Robin A., Anderson, John H., McKee, Ruth F., Horgan, Paul G., McMillan, Donald C.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-12-2012; Springer Nature B.V
• Subjects: Aged; Anastomotic Leak; Biomarkers - analysis; C-Reactive Protein - metabolism; Colorectal Cancer; Colorectal Neoplasms - blood; Colorectal Neoplasms - complications; Colorectal Neoplasms - surgery; Colorectal Surgery - adverse effects; Early Diagnosis; Female; Follow-Up Studies; Humans; Inflammation - blood; Inflammation - diagnosis; Inflammation - etiology; Length of Stay; Male; Medicine; Medicine & Public Health; Neoplasm Staging; Oncology; Postoperative Complications; Postoperative Period; Prognosis; ROC Curve; Surgery; Surgical Oncology; Surgical Wound Infection - blood; Surgical Wound Infection - diagnosis; Surgical Wound Infection - etiology; White Cell Count; Infective Complication; Anastomotic Leak; Colorectal Cancer Resection; Postoperative Systemic Inflammatory Response
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-012-2498-9

Background
Infective complications particularly in the form of surgical site infections including anastomotic leak represent a serious morbidity after colorectal cancer surgery. Systemic inflammation markers, including C-reactive protein (CRP) and white cell count, have been reported to provide early detection. However, their relative predictive value is unclear. The aim of the present study was to examine the diagnostic accuracy of serial postoperative WCC, albumin and CRP in detecting infective complications.
Methods
White cell count, albumin and CRP were measured postoperatively for 7 days in 454 consecutive patients undergoing surgery for colorectal cancer. All postoperative complications were recorded. The diagnostic accuracy of the white cell count, albumin and CRP values were analyzed by receiver operating characteristics curve analysis with surgical site infective complications as outcome measures.
Results
One hundred four patients (23 %) developed infective complications, and 26 of them developed an anastomotic leak. CRP was most sensitive to the development of an infective complication, surgical site or at a remote site. On postoperative day 3 CRP the area under the receiver operating characteristic curve was 0.80 (
p
 < 0.001) and the optimal cutoff value was 170 mg/L. This threshold was also associated with an increase in the length of hospital stay (
p
 < 0.001), 30 day mortality (
p
 < 0.05) and 12 month mortality (
p
 < 0.10).
Conclusions
Postoperative CRP measurement on day 3 postoperatively is clinically useful in predicting surgical site infective complications, including an anastomotic leak, in patients undergoing surgery for colorectal cancer.