Abstract
Objective: to determine the feasibility of using C-reactive protein (CRP) and cholesterol levels as biochemical screening markers for multiple organ dysfunction syndrome (MODS) in patients after abdominal surgery.Materials and methods. A prospective case-control study was performed in 192 patients who receivedtreatment at the Intensive Care Unit (ICU) after abdominal surgery. Patients were classified into two groups: Group 1 (n=95) of patients without MODS and Group 2 (n=97) of patients with MODS. The signs of MODS were identified based on 2001 SCCM/ACCP consensus conference criteria. During the first three post-operative days, total cholesterol and CRP levels were measured, and severity was assessed using prognostic scoring systems (SOFA and Apache III). Logistic regression analysis was used to evaluate five MODS prediction models based on total cholesterol levels, CRP levels, a combination of cholesterol and CRP levels as well as SOFA and Apache III scores.Results. Cholesterol levels in Group 2 were found to be significantly lower than those in Group 1 (3.13 (2.6–3.74) mmol/l vs 4.09 (3.26–5.01) mmol/l; P0.05). Significantly increased CRP levels in Group 2 compared to Group 1 were found (168.7 (90.2–247.2) mg/l vs 85.9 (35.6–172.6) mg/l; P0.05). AUC, sensitivity, and specificity values were determined for the study models and scales based on total cholesterol levels (AUC 0.679; 95% confidence interval (CI) 0.625–0.732), CRP levels (AUC 0.67; 95% CI 0.6–0.74), a combination of cholesterol and CRP levels (AUC 0.819; 95% CI 0.721–0.917), SOFA score (AUC 0.786; 95% CI 0.744–0.829), and Apache III score (AUC 0.631; 95% CI 0.582–0.68). The optimal threshold was 3.4 mmol/l and 96.5 mg/l for cholesterol and CRP levels, respectively.Conclusion. Total cholesterol and CRP monitoring revealed them as screening biomarkers informative for predicting MODS within the first three days after abdominal surgery. Using all these models, the probability of MODS development in a patient can be calculated as a function of the numerical value of the biomarker.
Highlights
The increasing number of surgical procedures in elderly and senile patients with comorbidities is a world-wide trend in abdominal surgery
The early identification of such patients and prognostic risk assessment ensures the timely admission to the intensive care unit (ICU) and immediate initiation of intensive therapy
Apache III and Sequential Organ Failure Assessment (SOFA) scores during the first three post-operative days were significantly higher in Group 2 (P 0.05, table 1)
Summary
The increasing number of surgical procedures in elderly and senile patients with comorbidities is a world-wide trend in abdominal surgery. To determine the risk of MODS, prognostic scoring systems (e.g. APACHE I–III, SUPPORT, HIS, TISS, POSSUM, SAPS I–II, RAPS, etc.) have been developed [3,4,5,6,7,8,9] Their use is restricted by both economic reasons and the need to measure a large number of clinical and laboratory parameters. Numerous laboratory tests are available for the same purpose (e.g. using procalcitonin, C-reactive protein (CRP), fibrinogen, or tumor necrosis factorα levels, leukocyte index, albumin or cholesterol levels, etc.) [10,11,12,13,14,15,16,17,18] Their informative value in patients after abdominal surgery is debatable [19,20,21]. Given the simplicity and cost-effectiveness of the assay, we chose CRP and cholesterol levels as the possible criteria/biomarkers
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