C-reactive protein for predicting postoperative infection after open versus laparoscopic surgery for gastrointestinal carcinoma

doi:10.3877/cma.j.issn.1674-0785.2018.01.005

Abstract

Abstract:

Objective

To compare the accuracy of C-reactive protein (CRP) in predicting postoperative infective complications after open versus laparoscopic surgery for gastrointestinal carcinoma.

Methods

During the period from December 2014 to January 2017, 354 patients with gastrointestinal cancer who underwent surgery at the First Hospital of China Medical University were included and divided into either an open surgery group or a laparoscopic surgery group according to operation method. Serum CRP levels were detected routinely from postoperative day (POD) 1 to POD 5, and receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of CRP in predicting postoperative infective complications in the two groups.

Results

ROC curve analysis showed that CRP level on POD 4 had the highest accuracy in predicting postoperative infection in the open surgery group (AUC = 0.740), yielding a sensitivity of 60.5% and a specificity of 80.0%, at the best threshold (cut-off) of 112.50 mg/L. In the laparoscopic surgery group, CRP level on POD 2 had the highest accuracy in predicting postoperative infective complications (AUC = 0.860), with a sensitivity of 78.6% and a specificity of 80.9%, at the best threshold (cut-off) of 142.50 mg/L.

Conclusion

The accuracy of CRP level for predicting postoperative infection after laparoscopic surgery for gastrointestinal carcinoma is superior to that after traditional open surgery, and the development of postoperative infective complications should be suspected when CRP is> 142.50 mg/L on day 2 after laparoscopic surgery.

Key words: C-reactive protein, Gastrointestinal cancer, Postoperative infection

Pengpeng Xu, Yuhang Lin, Hui Li, Huimian Xu, Baojun Huang. C-reactive protein for predicting postoperative infection after open versus laparoscopic surgery for gastrointestinal carcinoma[J]. Chinese Journal of Clinicians(Electronic Edition), 2018, 12(01): 29-34.

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References 19

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感染性并发症	例数	年龄（岁）	性别（男/女）	体质量指数（kg/m²）	ASA[%（例）]分级			肿瘤种类[%（例）]
感染性并发症	例数	年龄（岁）	性别（男/女）	体质量指数（kg/m²）	Ⅰ级	Ⅱ级	Ⅲ级	胃癌	结肠癌	直肠癌
是	124	64.65±10.29	86/38	23.04±3.56	8.0（10）	72.6（90）	19.4（24）	63.7（79）	17.7（22）	18.6（23）
否	230	60.12±10.47	144/86	23.16±3.09	18.7（43）	71.7（165）	9.6（22）	41.7（96）	27.0（62）	31.3（72）
统计值	?	t=3.912	χ²=1.611	t=-0.324	χ²=12.032			χ²=15.634
P值	?	<0.001	0.204	0.746	0.002			<0.001
感染性并发症	例数	手术方法[%（例）]		TNM分期[%（例）]
感染性并发症	例数	开腹	腹腔镜	Ⅰ期	Ⅱ期	Ⅲ期	Ⅳ期
是	124	67.7（84）	32.3（40）	10.5（13）	33.1（41）	44.4（55）	11.3（14）
否	230	56.1（129）	43.9（101）	21.3（49）	33.9（78）	35.7（82）	6.5（15）
统计值		χ²=4.566		χ²=9.335
P值		0.033		0.053

感染性并发症	例数	年龄（岁）	性别（男/女）	体质量指数（kg/m²）	ASA[%（例）]分级			肿瘤种类[%（例）]
感染性并发症	例数	年龄（岁）	性别（男/女）	体质量指数（kg/m²）	Ⅰ级	Ⅱ级	Ⅲ级	胃癌	结肠癌	直肠癌
是	124	64.65±10.29	86/38	23.04±3.56	8.0（10）	72.6（90）	19.4（24）	63.7（79）	17.7（22）	18.6（23）
否	230	60.12±10.47	144/86	23.16±3.09	18.7（43）	71.7（165）	9.6（22）	41.7（96）	27.0（62）	31.3（72）
统计值	?	t=3.912	χ²=1.611	t=-0.324	χ²=12.032			χ²=15.634
P值	?	<0.001	0.204	0.746	0.002			<0.001
感染性并发症	例数	手术方法[%（例）]		TNM分期[%（例）]
感染性并发症	例数	开腹	腹腔镜	Ⅰ期	Ⅱ期	Ⅲ期	Ⅳ期
是	124	67.7（84）	32.3（40）	10.5（13）	33.1（41）	44.4（55）	11.3（14）
否	230	56.1（129）	43.9（101）	21.3（49）	33.9（78）	35.7（82）	6.5（15）
统计值		χ²=4.566		χ²=9.335
P值		0.033		0.053

感染性并发症	术后1 d	术后2 d	术后3 d	术后4 d	术后5 d
是	122.96（88.50~133.00）	168.40（124.50~204.50）	150.11（131.50~158.50）	126.17（90.33~142.25）	75.39（63.50~87.88）
否	97.61（76.50~114.00）	146.97（116.50~171.50）	132.73（114.50~147.50）	95.72（77.25~109.00）	60.70（50.00~74.60）
t值	2.049	2.533	2.201	3.276	3.088
P值	0.050	0.014	0.031	0.002	0.003

感染性并发症	术后1 d	术后2 d	术后3 d	术后4 d	术后5 d
是	122.96（88.50~133.00）	168.40（124.50~204.50）	150.11（131.50~158.50）	126.17（90.33~142.25）	75.39（63.50~87.88）
否	97.61（76.50~114.00）	146.97（116.50~171.50）	132.73（114.50~147.50）	95.72（77.25~109.00）	60.70（50.00~74.60）
t值	2.049	2.533	2.201	3.276	3.088
P值	0.050	0.014	0.031	0.002	0.003

感染性并发症	术后1 d	术后2 d	术后3 d	术后4 d	术后5 d
是	86.75（58.23~102.75）	174.60（144.25~205.00）	143.36（116.00~171.50）	100.41（73.30~125.00）	71.63（41.40~81.40）
否	59.24（35.58~81.13）	117.83（96.70~135.00）	90.99（77.50~105.00）	56.39（38.22~72.60）	36.80（20.75~43.60）
t值	3.010	5.616	7.248	6.298	5.213
P值	0.005	<0.001	<0.001	<0.001	<0.001

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