McOwan Mark, Johnson Mary Ann, Ward Salena, Read Matthew, Chong Lynn, Taylor Lillian, Hii Michael W
St Vincent's Hospital, Melbourne, Australia.
Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia.
J Gastrointest Oncol. 2023 Feb 28;14(1):64-72. doi: 10.21037/jgo-22-675. Epub 2022 Dec 27.
Post-operative complications are the main contributing factor to increased length of stay, increased cost of care and short-term mortality experienced by patients following gastrectomy. The purpose of this study was to determine the diagnostic accuracy of C-reactive protein (CRP) in predicting complications following gastrectomy. This may assist clinicians to make better informed clinical decisions in the post-operative period.
A retrospective analysis of a prospectively maintained database was performed. Sixty patients who underwent gastrectomy for gastric cancer were included. Demographic information, operative data and post-operative details such as complications, unplanned intensive care unit (ICU) admission and readmission to hospital were analysed. Complications were further analysed based on whether they were either infective or non-infective in nature. Receiver operator characteristic (ROC) analysis was performed to examine the association between CRP and post-operative morbidity. Optimum cut-offs were determined using the Youden's index.
From the second post-operative day (POD), CRP levels were able to predict subsequent severe infective (SI) complications following gastrectomy [area under the curve (AUC): 0.789, 95% CI : 0.636-0.941]. An optimum cut-off of 180 mg/L resulted in a sensitivity of 87.50%. The negative predictive value (NPV) at this point was 96.30%.
CRP is a strong negative predicter of SI complications following gastrectomy. This suggests early CRP values may be useful in prompting early investigation or facilitating safer, earlier discharge from hospital. Health services may benefit by determining similar cut-offs based on their own unique patient populations.
术后并发症是导致胃癌切除术后患者住院时间延长、护理成本增加和短期死亡率上升的主要因素。本研究的目的是确定C反应蛋白（CRP）在预测胃癌切除术后并发症方面的诊断准确性。这可能有助于临床医生在术后做出更明智的临床决策。
对一个前瞻性维护的数据库进行回顾性分析。纳入60例行胃癌切除术的患者。分析人口统计学信息、手术数据和术后细节，如并发症、非计划入住重症监护病房（ICU）和再次入院情况。根据并发症的性质是感染性还是非感染性进一步分析。进行受试者操作特征（ROC）分析以检验CRP与术后发病率之间的关联。使用约登指数确定最佳临界值。
从术后第二天（POD）起，CRP水平能够预测胃癌切除术后随后发生的严重感染性（SI）并发症[曲线下面积（AUC）：0.789，95%可信区间：0.636 - 0.941]。最佳临界值为180 mg/L时，敏感性为87.50%。此时的阴性预测值（NPV）为96.30%。
CRP是胃癌切除术后SI并发症的有力阴性预测指标。这表明早期CRP值可能有助于促使早期检查或促进更安全、更早出院。卫生服务机构通过根据自身独特的患者群体确定类似的临界值可能会受益。
