Perioperative C-reactive Protein Research Articles

Correlation between C-reactive protein and postoperative mortality in patients undergoing hip fracture surgery: a meta-analysis

BackgroundHip fracture is a common but devastating disease with a high mortality rate in the older adult population. C-reactive protein (CRP) is a predictor of the prognosis in many diseases, but its correlations with patient outcomes following hip fracture surgery remain unclear. In this meta-analysis, we investigated the correlation between perioperative CRP level and postoperative mortality in patients undergoing hip fracture surgery.MethodsPubMed, Embase, and Scopus were searched for relevant studies published before September 2022. Observational studies investigating the correlation between perioperative CRP level and postoperative mortality in patients with hip fracture were included. The differences in CRP levels between the survivors and nonsurvivors following hip fracture surgery were measured with mean differences (MDs) and 95% confidence intervals (CIs).ResultsFourteen prospective and retrospective cohort studies comprising 3986 patients with hip fracture were included in the meta-analysis. Both the preoperative and postoperative CRP levels were significantly higher in the death group than in the survival group when the follow-up duration was ≥ 6 months (MD: 0.67, 95% CI: 0.37–0.98, P < 0.0001; MD: 1.26, 95% CI: 0.87–1.65, P < 0.00001, respectively). Preoperative CRP levels were significantly higher in the death group than in the survival group when the follow-up duration was ≤ 30 days (MD: 1.49, 95% CI: 0.29–2.68; P = 0.01).ConclusionsBoth higher preoperative and postoperative CRP levels were correlated with higher risk of mortality following hip fracture surgery, suggesting the prognostic role of CRP. Further studies are warranted to confirm the ability of CRP to predict postoperative mortality in patients with hip fracture.

The Role of Perioperative C-Reactive Protein in Predicting the Prognosis of Epithelial Ovarian Carcinoma.

Increasing epidemiological evidence supported that chronic inflammatory factors might be involved in the carcinogenesis and progression of various cancers. The present study tried to investigate the prognostic value of perioperative C-reactive protein (CRP) in prognosis of patients with epithelial ovarian carcinoma (EOC) from a tertiary university teaching hospital. The cutoff value of CRP was calculated according to receiver operating characteristic (ROC) curve. Variables were compared using Chi-square test. Progress-free survival (PFS) and overall survival (OS) time were assessed by Kaplan-Meier (KM) survival analysis and Log rank test based on serum CRP level. Univariate and multivariate Cox regression analyses were applied for assessing the relationship between clinicopathological parameters and survival. Higher perioperative CRP levels (preoperative ≥5.15 mg/L and postoperative ≥72.45 mg/L) were significantly associated with serous tumor, high-grade, advanced stage, elevated preoperative CA125, suboptimal surgery, chemotherapy resistance, recurrence and death in EOC (P < 0.01). KM analysis suggested patients with elevated preoperative, postoperative and perioperative CRP had shorter survival (P < 0.01). Elevated perioperative CRP was an independent risk factor for PFS (HR 1.510, 95% CI 1.124-2.028; P = 0.006) and OS (HR 1.580, 95% CI 1.109-2.251; P = 0.011). Similar results were obtained for elevated preoperative CRP. Subgroup analysis further suggested that elevated perioperative CRP was also an independent risk factor for prognosis in advanced stage and serous EOC. Elevated perioperative CRP was an independent risk factor for poorer prognosis of EOC, particularly in advanced stage and serous patients.

Retrospective Study from a Single Center on the Efficacy of Pulsed Lavage Following Excision of Burns ≥30% of the Total Body Surface Area in 63 Patients.

BACKGROUND Ensuring the take rate of skin grafting and reducing the mortality of patients with severe burns have remained big challenges worldwide. This retrospective study from a single center aimed to evaluate the efficacy of pulsed lavage following excision of burns ≥30% of the total body surface area (TBSA) in 63 patients. MATERIAL AND METHODS Among 63 patients, the types of burns sustained were severe burns and extremely severe burns (≥30% TBSA). The degrees of the burns were second degree and third degree, and the causes were thermal, chemical, and electric. Patients with early aggressive excision were divided into a pulsed lavage group and control group. The constituent of the lavage fluid was 0.9% physiological saline. The evaluation of wound healing and complications was based on the wound healing rate and time, clinical symptoms, and examination. We determined the take rate of skin grafting, positive rate of postoperative bacterial cultures, changes in perioperative serum C-reactive protein (CRP) and procalcitonin (PCT) levels, and incidence of secondary grafting. RESULTS The take rate of skin grafting and the decreased rates of perioperative serum CRP and PCT levels were significantly higher in the pulsed lavage group than in the control group (P<0.05). Moreover, the positive rate of wound postoperative bacterial cultures and mortality in the pulsed lavage group showed remarkably lower levels (P<0.05). CONCLUSIONS Pulsed lavage following excision of burns ≥30% TBSA increased the take rate of skin grafting, alleviated the positive rate of postoperative bacterial cultures, decreased serum CRP and PCT levels, and reduced mortality.

Serum anti-Müllerian hormone recovery after ovarian cystectomy for endometriosis: A retrospective study among Korean women.

Serum anti-Müllerian hormone (sAMH) is a useful marker of ovarian reserve. In many patients, the sAMH levels gradually recover after falling to the lowest level after surgery (nadir phenomenon). This study aimed to analyze the factors related to sAMH recovery from the nadir after an ovarian cystectomy for endometriosis among Korean women. A total of 159 patients with ovarian endometriosis were included in the study. The sAMH levels were measured before surgery and at least twice within 12 months after the surgery. The patients were divided into two groups: those with recovery (nadir group) and those without recovery (reduction group). Postoperative recovery of the sAMH levels from the nadir was not related to the stage and bilaterality of the lesion, surgical methods, such as robot-assisted or laparoscopic surgery, or surgical time. In the nadir group, the level of preoperative cancer antigen 125 was significantly higher, and it decreased significantly after the surgery than in the reduction group (P = .02 and P = .02). Additionally, the postoperative C-reactive protein (CRP) level was significantly higher in the nadir group, and it increased significantly after the surgery than in the reduction group (P = .03 and P = .04). The increasing degree of perioperative CRP level showed a cutoff value on the receiver operating characteristic curve (0.735 mg/dL, area under curve = 0.604; P = .04). Increased serum CRP levels after surgery are significantly related to the recovery of sAMH levels from the nadir. Therefore, postoperative serum CRP level could be used as a marker to predict the sAMH nadir after surgery.

Enhanced recovery after surgery in patients undergoing laparoscopic common bile duct exploration: A retrospective study.

SummaryFew reports have focused on the use of enhanced recovery after surgery (ERAS) in laparoscopic common bile duct exploration (LCBDE) to promote the postoperative recovery of patients with choledocholithiasis. Therefore, this study aimed to explore the advantages and safety of ERAS in patients who underwent LCBDE. From December 2016 to February 2020, 86 and 84 patients were retrospectively enrolled in the control and ERAS groups, respectively. The perioperative insulin resistance index, perioperative C-reactive protein level, time of postoperative analgesic use, time of postoperative first flatus, time of abdominal drainage tube removal, time of liver function recovery, and postoperative complications were analyzed between the two groups. The insulin resistance index (1, 3, and 5 days postoperatively) and C-reactive protein level (1, 3, 5, and 7 days postoperatively) in the ERAS group were significantly lower than those in the control group (all P < .05). In terms of the postoperative rehabilitation efficacy, the time of postoperative activity of the patient, time of postoperative first flatus, time of postoperative analgesic use, time of abdominal drainage tube removal, time of postoperative T-tube closing, and length of postoperative hospital stay in the ERAS group were significantly shorter than those in the control group (all P < .05). Additionally, the overall incidence of postoperative complications in the ERAS group had a decreasing trend when compared with that in the control group (P = .05). ERAS can reduce the postoperative stress response and postoperative complications of patients undergoing LCBDE, promote rehabilitation and shorten the length of postoperative hospital stay and therefore has good social and economic benefits.

Trend of Perioperative CRP (C-Reactive Protein) Levels in Non-Infected Total Knee Arthroplasty

The aim of this prospective study was to define the perioperative trend of C-reactive protein (CRP) in non-infected total knee arthroplasty (TKA). CRP was evaluated in 42 patients the day before surgery and 4 and 30 days after surgery. Functional and radiological evaluation was scheduled for 3, 6, and 12 months after surgery. Preoperatively, the median CRP was 3.2 mg/L (IQR,3.2-4.2) (reference range, 0-5 mg/L); 4 and 30 days after surgery, it measured 57.6 mg/L (IQR,36.1-96.4) and 5.3 mg/L (IQR,3.0-11.8), respectively. There were significant differences between the CRP preoperatively and 4 days after surgery (p<0.001) and between CPR levels 4 and 30 days after surgery (p<0.001) but not between CRP values preoperatively and 30 days after surgery (p=0.181). Higher preoperative CRP was associated to heart disease and chronic renal failure (r=0.329, p=0.036, and r=0.437, p=0.004, respectively). Four days after surgery, higher CRP was associated to older patients (r=0.311, p=0.048). In summary, 30 days after primary non-infected TKA, CRP levels were comparable to preoperative values. Older age and comorbidities should be carefully evaluated using postoperative CRP as diagnostic marker for the early detection of infection.

MP12-01 C-REACTIVE PROTEIN KINETICS TO PREDICT RECURRENCE AFTER RADICAL SURGERY FOR HIGH-RISK RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022MP12-01 C-REACTIVE PROTEIN KINETICS TO PREDICT RECURRENCE AFTER RADICAL SURGERY FOR HIGH-RISK RENAL CELL CARCINOMA Yudai Ishiyama, Tsunenori Kondo, Hiroki Ishihara, Kazuhiko Yoshida, Junpei Iizuka, Kazunari Tanabe, and Toshio Takagi Yudai IshiyamaYudai Ishiyama More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Hiroki IshiharaHiroki Ishihara More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Kazunari TanabeKazunari Tanabe More articles by this author , and Toshio TakagiToshio Takagi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002534.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With new options appearing in adjuvant setting, clinical biomarkers to predict recurrence after radical surgery for high-risk renal cell carcinoma (hrRCC) is in need but scarcely investigated. We aimed to verify the predictive value of perioperative C-reactive protein (CRP) kinetics on RCC recurrence. METHODS: We retrospectively evaluated 154 patients who underwent curative surgery for high-risk (≥pT3 or N0-2 and M0) RCC at two institutions between 2008 and 2020. Serum CRP (mg/dL) within one months before (baseline) and within three months (post) after surgery were obtained. Patients were classified into Normal (<0.5 at baseline) and High (≥0.5 at baseline) according to baseline CRP. The High group were further classified into Normalized (<0.5 at post) or non-normalized (≥0.5 at post), and recurrence-free survival (RFS) was compared between groups. Factors for RFS were further analyzed using multivariable Cox hazards model. C-index for accuracy of predicting RFS was compared with and without addition or CRP kinetics to preexisting models. RESULTS: The RFS was significantly shorter in High (n=72, 46.8) compared to Normal (n=82, 53.2%) group (9.7 vs. 66.7 months, p <0.001). Within High group, non-normalized (n=27, 17.5%) patients showed significantly shorter RFS compared to Normalized (n=45, 29.2%) group (6.2 vs. 10.0, p=0.013). In the multivariable analysis both baseline CRP (HR: 2.05, p=0.003) and kinetics (HR: 2.62, p <0.001) effectively predicted RFS, with HR being higher for kinetics. Higher C-index improvement was observed with CRP kinetics than the baseline CRP levels when added to factors included in Karakiewicz and UCLA Integrated Staging System models. CONCLUSIONS: CRP kinetics effectively predict RCC recurrence after surgery, and may aid in decision-making for adjuvant systemic therapy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e165 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yudai Ishiyama More articles by this author Tsunenori Kondo More articles by this author Hiroki Ishihara More articles by this author Kazuhiko Yoshida More articles by this author Junpei Iizuka More articles by this author Kazunari Tanabe More articles by this author Toshio Takagi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Changes in perioperative C-reactive protein levels in patients with rheumatoid arthritis undergoing total knee arthroplasty in the biologic era.

ABSTRACTThis study aimed to investigate changes in and factors associated with perioperative serum C-reactive protein (CRP) levels in rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA) in the biologic era. A total of 173 patients (228 knees) with RA underwent elective primary TKA at our institute between January 1, 2006 and December 31, 2018. Of these, 214 cases among 161 patients were examined in this retrospective study after excluding 3cases among 3 patients who developed postoperative complications and 11 cases among 9 patients who were treated with tocilizumab. Factors associated with changes in CRP levels between baseline (preoperative) and day 7 after TKA [ΔCRP (0–7days)] were assessed by multiple regression analysis. Median (interquartile range) CRP levels were 0.69 (0.21, 1.82) mg/dl preoperatively, 5.66 (4.21, 7.61) mg/dl on postoperative day 1, 12.75 (9.79, 16.74) mg/dl on postoperative days 3–4, 3.26 (2.21, 4.85) mg/dl on postoperative day 7, and 0.87 (0.45, 1.81) mg/dl on postoperative day 14. Multivariate regression analysis revealed that body mass index ≥25 [partial regression coefficient (B)=1.03, P=0.012] and use of glucocorticoids (B=–0.86, P=0.017) were independently associated with ΔCRP (0–7days), whereas use of methotrexate and targeted drug modifying antirheumatic drugs and preoperative CRP levels (an objective biomarker of RA activity) were not. In conclusion, serum CRP levels increased rapidly after TKA and peaked on postoperative days 3–4, followed by a return to preoperative levels by postoperative day 14 in patients with RA. Obesity and the use of glucocorticoids were independently associated with changes in CRP levels.

Effect of enhanced recovery after surgery on surgical stress response in patients with gastric cancer complicated with type 2 diabetes mellitus

Objective: To investigate the effect of enhanced recovery after surgery on the stress response of gastric cancer patients complicated with type 2 diabetes mellitus. Methods: We retrospectively analyzed the data of 49 patients with type 2 diabetes who underwent radical gastrectomy for gastric cancer in the Department of gastroenterology of the Affiliated Hospital of Jiangsu University from Jan to Dec 2020. They were randomly divided into experimental group and control group according to different perioperative management measures. The perioperative C-reactive protein (CRP), white blood cell (WBC), interleukin-6(IL-6), insulin resistance (HOMA-IR), blood glucose fluctuation and postoperative recovery were compared between the two groups. Results: A total of 49 patients were enrolled in the study (23 in the experimental group and 26 in the control group). The degree of stress reaction of the experimental group was lighter than that of the control group. The levels of CRP were significantly different on the 5th and 7th day after operation, IL-6 was significantly different on the 1st, 3rd, 5th and 7th day after operation, WBC and HOMA-IR were significantly different on the 1st day postoperatively. And the changes of HOMA-IR and blood glucose in experimental group were more gentle than those in control group. All the differences were statistically significant(P<0.05). In the experimental group, the time of first anal exhaust, indwelling time of drainage tube or nasointestinal tube and the total hospitalization time were significantly shorter than those of the control group(P<0.05). Conclusion: ERAS can reduce the degree of inflammatory stress and the postoperative IR level promote the early recovery of patients with gastric cancer complicated with type 2 diabetes mellitus.

C-reactive protein kinetics to predict recurrence of high-risk renal cell carcinoma after radical surgery.

With new options in adjuvant settings, clinical biomarkers to predict recurrence after radical surgery for high-risk renal cell carcinoma (hrRCC) are in need but are scarcely investigated. We aimed to verify the predictive value of perioperative C-reactive protein (CRP) kinetics on hrRCC recurrence. We retrospectively evaluated 154 patients who underwent radical surgery for hrRCC (≥ pT3 and/or N1-2 and M0) at two institutions. Patients were classified into Normal (< 0.5) and High (≥ 0.5) according to their preoperative serum CRP (mg/dL). The High group were further classified into Normalized (< 0.5 at post) or Non-normalized (≥ 0.5 at post), and recurrence-free survival (RFS) was compared between groups. Factors for RFS were further analysed, and Harrell's concordance index (C-index) for the accuracy of predicting RFS was compared with and without the addition of CRP-related variables to pre-existing models. The RFS was significantly shorter in the High (n = 72, 46.8%) compared to the Normal (n = 82, 53.2%) group (9.7 vs. 66.7months, p < 0.001). Within the High group, Non-normalized (n = 27, 17.5%) patients showed a significantly shorter RFS compared to the Normalized (n = 45, 29.2%) group (6.2 vs. 20.3, p = 0.009). In the multivariable stepwise analysis, CRP kinetics (hazard ratio 2.15, p = 0.029) effectively predicted RFS while baseline CRP fell short of significance. Higher C-index improvement was observed with CRP non-normalization than the baseline value when added to factors in the Karakiewicz and University of California Los Angeles Integrated Staging System models. CRP kinetics effectively predicted RCC recurrence after surgery and may aid in decision-making for adjuvant systemic therapy.

C-reactive protein adjusted for body mass index as a predictor of postoperative complications following laparoscopic gastrectomy for gastric cancer.

This study aimed to clarify the relationship between obesity and postoperative C-reactive protein (CRP) and assess the usefulness of obesity status-adjusted CRP levels for predicting early complications following laparoscopic gastrectomy for gastric cancer. This study retrospectively analyzed 527 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2013 and March 2019. Patients were classified into three groups according to body mass index (BMI): BMI < 20; BMI ≥ 20 to < 25; and BMI ≥ 25. The correlation between BMI and perioperative CRP was investigated in 447 patients, excluding 80 with postoperative complications. The optimal CRP cutoff value of Clavien-Dindo (CD) grade ≥ 3 for predicting severe complications for each group was determined. BMI was significantly correlated with CRP on postoperative day (POD) 3 (p < 0.001) in 447 patients without complications. According to the receiver operating characteristic curve analysis, CRP cutoff values on POD 3 for predicting severe complications were 92.4, 111.1, and 171.9 in the BMI < 20, BMI ≥ 20 to < 25, and BMI ≥ 25 groups, respectively. In multivariate analysis for CD grade ≥ 3 complications, cardiac history and POD 3 CRP levels higher than the adjusted cutoff were identified as independent factors significantly associated with severe complications (p = 0.021 and 0.015, respectively). CRP cutoff values on POD 3 adjusted for BMI were useful for predicting severe complications in gastrectomy for gastric cancer.

Prediction and early diagnosis of post hepatectomy complications

Introduction: The role of perioperative clinical and laboratory characteristics in the prevention and early diagnosis of postoperative complications (POC) after hepatectomy has not been established despite their potential usefulness. The aim of this study was to assess some clinical and analytic variables for the prevention and early diagnosis of POC after hepatectomy. Methods: Perioperative demographic, clinical, tumor related and laboratory characteristics of 194 consecutive patients who underwent liver resection between January 2017 and July 2020 were analysed. Laboratory values included preoperative and early postoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and c-reactive protein (CRP). The relationship between perioperative clinical variable, NLR, LMR, CRP and POC was evaluated using univariable and multivariable logistic regression analyses. Receiver-operating characteristic (ROC) curve was used to measure the accuracy of postoperative CRP in diagnosing complications, and Youden index was used to find the most accurate cutoff value. Results: Elevated day-3 postoperative CRP (HR: 3.4; IQR: 1.9-6.4; p=0,01); elevated day-3 postoperative NLR (HR: 1.1, IQR 1-1.2, p=0,023) and day-3 abdominal pain (HR 3.6; IQR 1.8-7; p=0.001) were independent risk factors predicting POC. Area under the curve for postoperative day-3 CRP values as a predictor of POC was 0,658 (p<0,001) and 117mgr/L was the optimal cutoff with a sensitivity and specificity of 60% and 70% respectively. Conclusion: Elevated day-3 postoperative NLR, CRP and abdominal pain are useful for early diagnosis of complications in patients undergoing liver resection. Their use should be considered especially in the implementation of enhanced recovery program to minimize the risk of hospital readmission.

Perioperative CRP: A novel inflammation-based classification in gastric cancer for recurrence and chemotherapy benefit.

BackgroundPerioperative C‐reactive protein (CRP) levels have effects on the prognosis of cancer patients. We intended to determine the prognostic value of combining the two for gastric cancer (GC).MethodsData were extracted from a clinical trial. By calculating the area under the curve (AUC) and the C‐index, the predictive value of CRPs among different time points, including preoperative (pre‐CRP), postoperative days 1, 3, and 5 (post‐CRPs), and postoperative maximum CRP (post‐CRPmax), was derived. Multivariate analysis was performed to further explore the independent variates for recurrence‐free survival (RFS).ResultsFinally, 401 patients were available in the present study. For RFS, higher AUC (0.692) and concordance index (0.678) of pre‐CRP were observed when compared with those of post‐CRPs. Further, among post‐CRPs, post‐CRPmax had the highest predictive values (AUC: 0.591; concordance index: 0.585) among the other post‐CRPs. The threshold values in predicting RFS for pre‐CRP and post‐CRPmax were 3.1 mg/L and 77.1 mg/L. Multivariate analysis showed both pre‐CRP≥3.1 mg/L (high‐pre‐CRP) and post‐CRPmax≥77.1 mg/L (high‐post‐CRPmax) were risk factors for RFS. Postoperative chemotherapy benefit was further analyzed for patients with stage II/III GC and indicated that patients with pre‐CRP<3.1 mg/L had better prognosis without benefit from postoperative adjuvant chemotherapy (ACT), p = 0.557. In high‐pre‐CRP patients, only patients with post‐CRPmax≥77.1 mg/L but not post‐CRPmax<77.1 mg/L benefited from postoperative ACT (RFS: 33.2% vs 49.9% for non‐chemotherapy group and chemotherapy group, respectively, p = 0.037). Analyses for overall survival obtained the similar outcomes.ConclusionsBoth high‐pre‐CRP and high‐post‐CRPmax are associated with worse prognosis in GC. ACT seems to only improve the prognosis for stage II/III GC with pre‐CRP≥3.1 mg/L and post‐CRPmax≥77.1 mg/L after radical gastrectomy. Further studies are needed to confirm these findings and explore the potential mechanism.

C-reactive protein may rise after closed-suction drainage removal in patients undergoing revision arthroplasty: a retrospective study.

Serum C-reactive protein (CRP) has been one of the most commonly used markers to rule out early post-operative infection following total joint arthroplasty. The phenomenon that CRP values rise after prolonged drainage removal may occur in clinical settings. The purpose of this study is to investigate (i) the prevalence and risk factors of such a phenomenon and (ii) whether the raised CRP is associated with post-operative infection. A retrospective review of 72 revision arthroplasties of the knee and hip with prolonged drainage from 2011 to 2016 was conducted. Perioperative CRP levels were obtained, and patients were divided into two groups according to whether CRP levels were elevated after drainage removal (raised CRP group and control group). Multivariate logistic regression analyses were performed to identify risk factors of raised CRP after drainage removal. The incidence of post-operative wound complications and infection was compared between groups. Overall, the prevalence of raised CRP after drainage removal was 29.17% (21/72). CRP level before drainage removal was associated with the occurrence of such a phenomenon (adjusted odds ratio per 10-mg/L increase 0.92, 95% confidence interval 0.87-0.97). The raised CRP levels decrease again within 3 days after drainage removal. There was no significant difference in the incidence of wound complications and infection between the raised CRP group and control group. Almost one in three patients have raised CRP values after prolonged drainage removal following revision arthroplasty. However, CRP values can decrease again within 3 days after drainage removal without specific management. Almost one in three patients have raised C-reactive protein values after prolonged drainage removal following revision arthroplasty. However, C-reactive protein values can decrease again within 3 days after drainage removal without specific management. Surgeons should remember that such a phenomenon may be not be a proxy for post-operative infection following revision arthroplasty.

Prognostic Significance of Perioperative C-Reactive Protein in Resected Non-Small Cell Lung Cancer

Inflammation is reportedly associated with the development and progression of various malignancies. However, the clinical significance of preoperative and postoperative inflammation in lung cancer patients undergoing surgery is unknown. The relationship between preoperative and postoperative C-reactive protein (CRP), an indicator of inflammation, and survival was retrospectively analyzed in 356 patients who underwent complete resection of pathologic Stage I and II non-small cell lung cancers. Cutoffs for preoperative CRP (CRPpre), postoperative maximum levels of CRP (CRPmax), and postoperative CRP levels 30 days after surgery (CRP30) were determined as 0.2 mg/dL, 6.4 mg/dL, and 0.2 mg/dL, respectively. Patients with CRPprehigh, CRPmaxhigh, or CRP30high status had significantly poorer overall survival (OS) and relapse-free survival (RFS) than those with CRPprelow, CRPmaxlow, or CRP30low. Patients were stratified into 4 groups according to perioperative CRP grades, combining CRPprehigh, CRPmaxhigh, and CRP30high statuses, yielding groups with grades 0, 1, 2, and 3. OS and RFS significantly worsened with increasing grade. After controlling for potential confounders, the multivariate Cox proportional hazard model revealed perioperative CRP grade as an independent poor prognostic factor for OS (grade 3 vs grade 0): adjusted hazard ratio, 5.05; 95% confidence interval, 1.59-19.6; P = 0.005), and RFS (adjusted hazard ratio, 3.62; 95% confidence interval, 1.50-9.33; P = 0.004). Perioperative inflammation was associated with a long-term negative prognostic impact after lobectomy for lung cancer. Further prospective analysis is required to identify whether control of perioperative inflammationmayimprove prognosis after lung cancer surgery.

Increased perioperative C-reactive protein and decreased postoperative albumin is associated with acute posttraumatic osteomyelitis in patients with high-energy tibial fractures

BackgroundEarly diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity. AimThe objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery. Patients and methodsThis prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4). ResultsWe discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM. ConclusionsWe can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.

Perioperative C-reactive protein is associated with pain outcomes after major laparoscopic abdominal surgery: a retrospective analysis.

Purpose: This study is aimed to investigate an association between perioperative C-reactive protein (CRP) levels and both opioid consumption and postoperative pain scores in postoperative days (PODs) in patients who underwent laparoscopic major abdominal surgery. We hypothesized that postoperative opioid requirements and numeric rating scale (NRS) pain scores would be positively associated with perioperative CRP levels.Patients and method: Medical records from 4,653 patients who underwent a laparoscopic major abdominal surgery from January 2010 to December 2016 were retrospectively reviewed. Generalized linear regression analysis was used to identify the association of preoperative and postoperative CRP levels, and increase in CRP level (postoperative CRP level – preoperative CRP level) with postoperative pain outcomes during POD 0–3.Results: An increase of 1 mg dL−1 of postoperative CRP level was significantly associated with 1.4% increase morphine equivalent consumption [exponentiated regression (Exp) coefficient: 0.014, 95% CI (0.011, 0.016), P<0.001], whereas preoperative CRP levels were not significantly associated with morphine equivalent consumption on POD 0–3 (P=0.450). A 1 mg dL−1 of increase in CRP level was significantly associated with 1% increase of morphine equivalent consumption [Exp coefficient: 0.010, 95% CI (0.008, 0.012), P<0.001]. Postoperative CRP levels were positively associated with NRS pain scores on POD 1, POD 2, and POD 3 (P<0.001). Increases of CRP levels were also positively associated with NRS pain scores on POD 0, POD 1, POD2, and POD3 (P<0.05).Conclusion: These results suggest postoperative CRP levels and increases in CRP levels are positively associated with opioid consumption and higher pain scores after major laparoscopic abdominal surgery.

C-reactive protein for early detection of postoperative systemic infections in intertrochanteric femoral fractures

BackgroundThis retrospective cohort study investigated perioperative C-reactive protein (CRP) value for early detection of postoperative systemic infective complications in elderly patients with intertrochanteric femoral fracture. MethodsA total of 250 patients aged ≥65 years, with intertrochanteric femoral fractures that were surgically treated between January 2011 and December 2015 were included. CRP value was measured preoperatively and on postoperative day (POD) 3, 5, and 10, and analyzed with regard to postoperative systemic infections, delirium, and death within 1 year. The patients were divided into two groups according to postoperative systemic infection, and perioperative CRP responses between the two groups were comparedusing t-test (or Man-Whitney test where appropriate). The receiver operator characteristic (ROC) curves of CRP value were used to determine the best-supported cut-off values for identifying postoperative systemic infections. Systemic infections were reclassified as pulmonary and extra-pulmonary infections. ResultsThe mean CRP values preoperatively and on POD 3, 5, and 10 were 2.82, 10.10, 3.74, and 1.89 mg/dL, respectively. Postoperative systemic infections, delirium, and death within 1 year were noted in 35 (14.0%), 30 (12.0%), and 45 (18.0%) patients, respectively. The CRP value in patients with postoperative systemic infections significantly elevated on POD 5 and 10 (p < 0.001, p < 0.001), and cut-off values were 4.71 and 1.59 mg/dL on POD 5 and 10, respectively. Postoperative delirium and death within 1 year were observed more often in the group with postoperative systemic infections (p = 0.003, p = 0.014). Although preoperatively elevated CRP values did not influence the postoperative CRP responses, they were significantly associated with delirium (p = 0.015). ConclusionsThe CRP value on POD 5 is the earliest predictor of postoperative systemic infections in elderly patients with intertrochanteric femoral fractures that are managed surgically. Moreover, when the CRP value on POD 5 is >4.71 mg/dL, the possibility of postoperative systemic infections should be considered. Level of evidenceIII, Retrospective cohort study.

Relationship Between Visceral Obesity and Postoperative Inflammatory Response Following Minimally Invasive Esophagectomy.

Esophagectomy for esophageal cancer is one of the most invasive surgeries. However, the factors influencing postoperative systemic inflammatory response following esophagectomy have not been elucidated. Recently, visceral fat has been shown to play an important role in both chronic and acute inflammation. In this study, we assessed the relationship between visceral obesity and postoperative inflammatory response following minimally invasive esophagectomy (MIE). Visceral fat area (VFA) was measured using computed tomography in 152 patients undergoing MIE for esophageal cancer. We assessed perioperative serum C-reactive protein (CRP) levels preoperatively and on postoperative days (PODs) 1-5 and analyzed the relationship between VFA and perioperative serum CRP levels. VFA was positively associated with preoperative serum CRP level (P < 0.001). Univariate analysis revealed that VFA was significantly associated with increased serum CRP levels on PODs 1-5 (P < 0.001 for each day), whereas multivariate analysis revealed that it was independently associated with increased serum CRP levels on PODs 1-4 (P = 0.033, 0.035, 0.001, and 0.006, respectively). Similar results were observed in patients who did not have postoperative infectious complications, such as pneumonia, anastomotic leak, and surgical site infection. VFA was not an independent risk factor for the occurrence of these postoperative infectious complications. Visceral obesity might be associated with chronic inflammation in patients with esophageal cancer and promote postoperative inflammatory response following MIE.

C-reactive protein levels in the perioperative period as a predictive marker of endoscopic recurrence after ileo-colonic resection for Crohn's disease.

The aim of this study was to determine the perioperative behavior of C-reactive protein (CRP) in Crohn’s disease (CD) patients undergoing elective ileo-cecal (IC) resection and to identify association between perioperative CRP levels and endoscopic recurrence at 1 year. Study hypothesis was that perioperative CRP changes are disease specific and could detect subset of patients with more aggressive pathopysiology. Seventy-five patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed: preoperative, postoperative day 1 (POD1) and day 5 (POD5). CD patients’ values were compared against same interval assessments of control groups undergoing right colectomy and appendicectomy. At POD1, the serum concentration increase was significantly higher in CD patients than in controls. Comparing with control groups, CRP levels remained remarkably high and showed a lower reduction in CD at POD5. Difference between groups was statistically significant. Optimal cutoff levels have been identified: serum CRP concentrations of >39.8 mg/l at POD1 and of >23.2 mg/l at POD5 have shown a significant association to endoscopic recurrence when using bivariate correlation. In this preliminary series, binary logistic regression could not demonstrate statistical relationship between endoscopic recurrence and any of the variables evaluated as prognostic factor. This is the only study so far that investigates and confirms a disease-specific upregulation of CRP response in the perioperative period for CD patients undergoing surgery. The postoperative CRP levels and kinetics seem to be related to the grade of mucosal inflammation and recurrence rate according to our 12 months endoscopic evaluation.