Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of inflammatory complications after open resection of colorectal cancer: a retrospective study of 1,187 patients

• Published in: International journal of colorectal disease Vol. 26; no. 11; pp. 1405 - 1413
• Main Authors: Warschkow, Rene, Tarantino, Ignazio, Torzewski, Michael, Näf, Franziska, Lange, Jochen, Steffen, Thomas
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-11-2011; Springer; Springer Nature B.V
• Subjects: Aged; Anastomosis, Surgical; Biological and medical sciences; Blood cell count; C-Reactive Protein; Cancer; Colorectal cancer; Colorectal Neoplasms - blood; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - surgery; Colorectal Surgery - adverse effects; Communications equipment; Complications and side effects; Early Diagnosis; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatology; Humans; Inflammation - complications; Inflammation - diagnosis; Internal Medicine; Leukocyte Count; Male; Medical sciences; Medicine; Medicine & Public Health; Oncology, Experimental; Original Article; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Period; Proctology; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Tumors; C-reactive protein; Colorectal; White blood cell count; ROC; Human; Rectal disease; Colorectal cancer; Surgical resection; Malignant tumor; Colonic disease; Accuracy; Treatment; Surgery; Gastroenterology; Digestive diseases; Intestinal disease; Complication; Diagnosis; C reactive protein; Blood cell count; Cancer
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-011-1262-0

Purpose
Although widely used, there is a lack of evidence concerning the diagnostic accuracy of C-reactive protein (CRP) and white blood cell counts (WBCs) in the postoperative period. The aim of this study was to evaluate the diagnostic accuracy of CRP and WBCs in predicting postoperative inflammatory complications after open resection of colorectal cancer.
Methods
In this retrospective study, clinical data and the CRP and WBCs, routinely measured until postoperative day 5 (POD 5), were available for 1,187 patients who underwent colorectal cancer surgery between 1997 and 2009. Using the receiver-operating characteristic (ROC) methodology, the diagnostic accuracy was evaluated according to the area under the curve (AUC).
Results
Three hundred forty-seven patients (29.2%; 95% CI, 26.7–31.9%) developed various inflammatory complications. Anastomotic leakage occurred in 8.0% (95% CI, 6.1–9.1%) of patients. The CRP level on POD 4 (AUC 0.76; 95% CI, 0.71–0.81) had the highest diagnostic accuracy for the early detection of inflammatory complications. With a cutoff of 123 mg/l, the sensitivity was 0.66 (95% CI, 0.56–0.74), and the specificity was 0.77 (95% CI, 0.71–0.82). The diagnostic accuracy of the WBC was significantly lower compared to CRP.
Conclusion
Measurement of CRP on POD 4 is recommended to screen for inflammatory complications. CRP values above 123 mg/l on POD 4 should raise suspicion of inflammatory complications, although the discriminatory performance was insufficient to provide a single threshold that could be used to correctly predict inflammatory complications in clinical practice. WBC measurement contributes little to the early detection of inflammatory complications.
Registered at
www.clinicaltrials.gov
(NCT01221324)