Department of Gastrointestinal surgery, Amsterdam UMC, VU University Medical Center, The Netherlands.
Department of Gastrointestinal surgery, Amsterdam UMC, VU University Medical Center, The Netherlands.
Surgery. 2021 Oct;170(4):1131-1139. doi: 10.1016/j.surg.2021.04.025. Epub 2021 May 21.
Infectious complications are frequently encountered after abdominal surgery. Early recognition, diagnosis, and subsequent timely treatment is the single most important denominator of postoperative outcome. This study prospectively addressed the predictive value of routine assessment of C-reactive protein levels as an early marker for infectious complications after major abdominal surgery.
Consecutive patients undergoing major abdominal surgery between November 2015 and November 2019 were prospectively enrolled. Routine C-reactive protein measurements were implemented on postoperative days 3, 4, and 5, and additional computed tomography examinations were performed on demand. The primary endpoint was the occurrence of Clavien-Dindo grade III or higher infectious complications.
Of 350 patients, 71 (20.3%) experienced a major infectious complication, and median time to diagnosis was 7 days. C-reactive protein levels were significantly higher in patients with major infectious complications compared to minor or no infectious complications. The optimal cut-off was calculated for each postoperative day, being 175 mg/L on day 3, 130 mg/L on day 4, and 144 mg/L on day 5, and corresponding sensitivities, specificities, and positive and negative predictive values were over 80%, 65%, 40%, and 92% respectively. Alternative safe discharge cut-offs were calculated at 105 mg/L, 71 mg/L and 63 mg/L on days 3, 4, and 5, respectively, each having a negative predictive value of over 97%.
The C-reactive protein cut-offs provided in this study can be used as a discharge criterion or to select patients that might require an invasive intervention due to infectious complications. These diagnostic criteria can easily be implemented in daily surgical practice.
腹部手术后常发生感染并发症。早期识别、诊断和随后及时治疗是术后结果的唯一最重要因素。本研究前瞻性评估了 C 反应蛋白（CRP）水平作为主要腹部手术后感染并发症的早期标志物的预测价值。
连续纳入 2015 年 11 月至 2019 年 11 月期间行腹部大手术的患者。术后第 3、4 和 5 天常规检测 CRP 水平，根据需要进行额外的 CT 检查。主要终点是发生 Clavien-Dindo 分级 III 或更高的感染性并发症。
350 例患者中，71 例（20.3%）发生严重感染并发症，中位诊断时间为 7 天。与无或轻微感染并发症的患者相比，严重感染并发症患者的 CRP 水平显著升高。计算出每个术后日的最佳截断值，分别为第 3 天 175mg/L、第 4 天 130mg/L 和第 5 天 144mg/L，相应的敏感度、特异度、阳性和阴性预测值分别超过 80%、65%、40%和 92%。还计算了替代的安全出院截断值，分别为第 3、4 和 5 天 105mg/L、71mg/L 和 63mg/L，每个截断值的阴性预测值均超过 97%。
本研究提供的 CRP 截断值可作为出院标准或用于选择因感染并发症可能需要侵入性干预的患者。这些诊断标准可以很容易地在日常外科实践中实施。
