Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
Langenbecks Arch Surg. 2024 Feb 27;409(1):76. doi: 10.1007/s00423-024-03266-3.
To assess the association of postoperative C-reactive protein (CRP), leucocytes and vital signs in the first three postoperative days (PODs) with major complications after oncological colorectal resections in a tertiary referral centre for colorectal cancer in The Netherlands.
A retrospective cohort study, including 594 consecutive patients who underwent an oncological colorectal resection at Maastricht University Medical Centre between January 2016 and December 2020. Descriptive analyses of patient characteristics were performed. Logistic regression models were used to assess associations of leucocytes, CRP and Modified Early Warning Score (MEWS) at PODs 1-3 with major complications. Receiver operating characteristic curve analyses were used to establish cut-off values for CRP.
A total of 364 (61.3%) patients have recovered without any postoperative complications, 134 (22.6%) patients have encountered minor complications and 96 (16.2%) developed major complications. CRP levels reached their peak on POD 2, with a mean value of 155 mg/L. This peak was significantly higher in patients with more advanced stages of disease and patients undergoing open procedures, regardless of complications. A cut-off value of 170 mg/L was established for CRP on POD 2 and 152 mg/L on POD 3. Leucocytes and MEWS also demonstrated a peak on POD 2 for patients with major complications.
Statistically significant associations were found for CRP, Δ CRP, Δ leucocytes and MEWS with major complications on POD 2. Patients with CRP levels ≥ 170 mg/L on POD 2 should be carefully evaluated, as this may indicate an increased risk of developing major complications.
评估荷兰一家癌症转诊中心在术后前 3 天（POD）内 C 反应蛋白（CRP）、白细胞和生命体征与肿瘤性结直肠切除术后主要并发症之间的关系。
回顾性队列研究，纳入 2016 年 1 月至 2020 年 12 月在马斯特里赫特大学医学中心接受肿瘤性结直肠切除术的 594 例连续患者。对患者特征进行描述性分析。使用逻辑回归模型评估 POD1-3 时白细胞、CRP 和改良早期预警评分（MEWS）与主要并发症的关系。使用受试者工作特征曲线分析确定 CRP 的截断值。
共有 364 例（61.3%）患者术后无并发症恢复，134 例（22.6%）患者发生轻微并发症，96 例（16.2%）患者发生严重并发症。CRP 水平在 POD2 达到峰值，平均为 155mg/L。无论并发症情况如何，疾病晚期和接受开放手术的患者的 CRP 峰值明显更高。确定 POD2 时 CRP 的截断值为 170mg/L，POD3 时 CRP 的截断值为 152mg/L。白细胞和 MEWS 也显示 POD2 时主要并发症患者的峰值。
在 POD2 时，CRP、Δ CRP、Δ白细胞和 MEWS 与主要并发症之间存在统计学显著关联。POD2 时 CRP 水平≥170mg/L 的患者应仔细评估，因为这可能表明发生严重并发症的风险增加。
