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

PLoS One. 2015 Jul 15;10(7):e0132995. doi: 10.1371/journal.pone.0132995. eCollection 2015.

Abstract

Background: 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.

Study design: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Abdomen / pathology
  • Abdomen / surgery*
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • Humans
  • Patient Discharge
  • Postoperative Complications / blood
  • Postoperative Complications / diagnosis*
  • Postoperative Period
  • Predictive Value of Tests
  • Regression Analysis

Substances

  • Biomarkers
  • C-Reactive Protein

Grants and funding

The authors received no specific funding for this work.