Predictive Value of C-Reactive Protein for Major Complications after Major Abdominal Surgery: A Systematic Review and Pooled-Analysis

• Published in: PloS one Vol. 10; no. 7; p. e0132995
• Main Authors: Straatman, Jennifer, Harmsen, Annelieke M K, Cuesta, Miguel A, Berkhof, Johannes, Jansma, Elise P, van der Peet, Donald L
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.07.2015; Public Library of Science (PLoS)
• Subjects: Abdomen; Abdomen - pathology; Abdomen - surgery; Abdominal surgery; Bibliographic data bases; Biomarkers - blood; C-reactive protein; C-Reactive Protein - metabolism; Colorectal surgery; Complications; Computed tomography; Control algorithms; Discharge; Gastrointestinal surgery; Humans; Laparoscopy; Medical libraries; Medical personnel; Morbidity; Mortality; Patient Discharge; Patients; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Period; Prediction models; Predictive Value of Tests; Proteins; Quality; Regression Analysis; Regression models; Statistical analysis; Studies; Surgery; Systematic review
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0132995

Early diagnosis and treatment of complications after major abdominal surgery can decrease associated morbidity and mortality. Postoperative CRP levels have shown a strong correlation with complications. Aim of this systematic review and pooled-analysis was to assess postoperative values of CRP as a marker for major complications and construct a prediction model. A systematic review was performed for CRP levels as a predictor for complications after major abdominal surgery (MAS). Raw data was obtained from seven studies, including 1427 patients. A logit regression model assessed the probability of major complications as a function of CRP levels on the third postoperative day. Two practical cut-offs are proposed: an optimal cut-off for safe discharge in a fast track protocol and another for early identification of patients with increased risk for major complications. A prediction model was calculated for major complications as a function of CRP levels on the third postoperative day. Based on the model several cut-offs for CRP are proposed. For instance, a two cut-off system may be applied, consisting of a safe discharge criterion with CRP levels below 75 mg/L, with a negative predictive value of 97.2%. A second cut-off is set at 215 mg/L (probability 20%) and serves as a predictor of complications, indicating additional CT-scan imaging. The present study provides insight in the interpretation of CRP levels after major abdominal surgery, proposing a prediction model for major complications as a function of CRP on postoperative day 3. Cut-offs for CRP may be implemented for safe early-discharge in a fast-track protocol and, secondly as a threshold for additional examinations, such as CT-scan imaging, even in absence of clinical signs, to confirm or exclude major complications. The prediction model allows for setting a cut-off at the discretion of individual surgeons or surgical departments.