Impact of Day 2 C‐Reactive Protein on Day 3 and 4 Thresholds Associated With Infective Complications Following Curative Surgery for Colorectal Cancer

Abstract

The postoperative systemic inflammatory response, as evidenced by C-reactive protein (CRP) on days 3 and 4, has been reported to be associated with the development of infective complications following surgery for colorectal cancer. However, patients in enhanced recovery after surgery require earlier assessment at day 2, the peak CRP response to surgery. The aim of the present study was to assess the impact of day 2 CRP on the CRP concentrations on days 3 and 4. Patients with colorectal cancer undergoing elective resection were recorded in a prospective database (n = 357). CRP was measured preoperatively and on days 1-4 postoperatively. Correlations between day 2 CRP and day 3 and day 4 CRP concentrations were examined. The majority of patients were ≥ 65 (72 %), male (53 %), underwent right or left hemicolectomy (63 %), and had node-negative disease (61 %). Day 2 CRP was not significantly associated with age, sex, operation type, or tumor stage. Day 2 CRP was directly associated with day 3 (r (2) = 0.601, p < 0.001) and day 4 (r (2) = 0.270, p < 0.001) CRP. The median day 2 CRP that corresponded with the previously described thresholds for predicting infective complications was ~190 mg/L, and for predicting an anastomotic leak 200 mg/L. A day 2 CRP concentration >190 mg/L was associated with day 3 and 4 CRP concentrations above established CRP thresholds for the development of infective complications.