Abstract
C-reactive protein (CRP) is a major acute phase protein showing increasing serum concentrations in dogs with systemic inflammation following e.g., surgery, trauma, infections, or neoplasia. CRP is a useful diagnostic marker of systemic inflammation in dogs and automated assays have been validated for reliable measurements for routine diagnostic purposes. In the present study available evidence for the use of CRP as a marker of surgery related systemic inflammation in dogs was reviewed and assessed. Two main themes were in focus: (1) canine CRP as a potential marker of postsurgical infectious complications and (2) canine CRP as a marker of the degree of surgical trauma. As outlined in the review several studies suggest that CRP is a useful marker for both purposes. However, the evidence level is limited and studies in the field are all affected by considerable risks of bias. Thus, further studies are needed in order to confirm the assumptions from previous studies and increase the level of evidence for CRP as a useful marker for detecting inflammation after surgery in dogs.
Highlights
The acute phase response is a non-specific reaction to any tissue stimulation disturbing the homeostasis e.g., surgery, trauma, infection, or neoplasia [1,2,3] and plays an important role as part of the innate immune system [1, 3]
This review evaluates C-reactive protein (CRP) as a marker of surgery related systemic inflammation in dogs
Elevated baseline concentrations of CRP were, observed in dental, orthopedic, elective ovariohysterectomy, and cancer patients included in the study of Yamamoto et al [9] and in 3 dogs before endoscopic transumbilical thoracic surgical lung biopsy in the study of Wen et al [27], but as no other information regarding the level of preoperative systemic inflammation was given in these publications, the exact cause of these elevations are not known
Summary
The acute phase response is a non-specific reaction to any tissue stimulation disturbing the homeostasis e.g., surgery, trauma, infection, or neoplasia [1,2,3] and plays an important role as part of the innate immune system [1, 3]. Outcome assessment was based on quantitative CRP concentrations measured at sequential time-points after surgery. The standard deviations of CRP concentrations are lower in this study [22] compared to other studies using the same assay for CRP measurements This could probably be explained by analytical bias. Uncontested of these risks of bias, persistently high or increasing concentrations of CRP have been suggested to indicate an ongoing inflammatory process, e.g., as a result of infection of the surgical wound [23]. Further studies are needed in order to further explore the usefulness of sequential measurements of CRP as predictor of infectious complications after surgery in dogs
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