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C-Reactive Protein Levels Predict Postoperative Septic Complications

C-Reactive Protein Levels Predict Postoperative Septic Complications Abstract • We studied 108 patients undergoing clean-contaminated and dirty surgical procedures to determine whether daily C-reactive protein (CRP) measurements for 14 days postoperatively could predict the occurrence of septic complications prior to clinical diagnosis. Diagnostic criteria for septic complications and positive CRP response were defined in advance of the study. The CRP assays were carried out using an automated laser nephelometer system after the patient's discharge from the hospital. Forty-six septic complications were diagnosed in 40 patients. These complications consisted of wound infection (23), urinary tract infection (11), pneumonia (six), upper respiratory tract infection (three), intra-abdominal abscess (one), and other (two). The CRP testing was found to have a positive predictive value of 69% and a negative predictive value of 78%. We conclude that serial CRP measurements may be a valuable adjunct to surgical care in patients at high risk of postoperative septic complications. (Arch Surg 1987;122:69-73) References 1. Pitcher WD, Musher DM: Critical importance of early diagnosis and treatment of intra-abdominal infection . Arch Surg 1982;117:328-333.Crossref 2. Dinarello CA: Interleukin 1 and the pathogenesis of the acute-phase response . N Engl J Med 1984;311:1413-1418.Crossref 3. Altemeier WA, Burke JF, Pruitt BA, et al: Manual on Control of Infections in Surgical Patients . Philadelphia, JB Lippincott Co, 1976. 4. Algorithms for diagnosing infections: Appendix E . Am J Epidemiol 1980;111:635-643. 5. Harmoinen A, Hallstrom O, Gronroos P: Rapid quantitative determination of C-reactive protein using laser-nephelometer . Scand J Clin Lab Invest 1980;40:293-295.Crossref 6. Haynes RB: How to read clinical journals: II. To learn about a diagnostic test . Can Med Assoc J 1981;124:703-710. 7. Abernathy TJ, Avery OT: The occurrence during acute infections of a protein not normally present in the blood: I. Distribution of the reactive protein in patients' sera and the effect of calcium on the flocculation reaction with the C-polysaccharide of the pneumococcus . J Exp Med 1941;73:173-181.Crossref 8. Gewurz J, Mold C, Siegel J, et al: C-reactive protein and the acute phase response . Adv Med 1982;27:345-373. 9. Kusherner I, Broder ML, Karp D: Control of the acute phase response: Serum C-reactive protein kinetics after acute myocardial infarction . J Clin Invest 1978;61:235-242.Crossref 10. Werner M: Serum protein changes during the acute phase reaction . Clin Chim Acta 1969;25:299-305.Crossref 11. Fischer CL, Gill C, Forrester MG, Nakamura R: Quantitation of acute-phase proteins' postoperatively: Value in detection and monitoring of complications. Am J Clin Pathol 1976;66:840-846. 12. Peltola HO: C-reactive protein for rapid monitoring of infections of the central nervous system . Lancet 1982;1:980-983.Crossref 13. Sabel KG, Hanson LA: The clinical usefulness of C-reactive protein determinations in bacterial meningitis and septicemia in infancy . Acta Paediatr Scand 1974;63:381-388.Crossref 14. Becker GJ, Waldburger M, Hughes GRV, et al: Value of C-reactive measurement in the investigation of fever in systemic lupus erythematosus . Ann Rheum Dis 1980;35:50-52.Crossref 15. Mackie PH, Crockson RA, Stuart J: C-reactive protein for rapid diagnosis of infection in leukemia . J Clin Pathol 1979;32;1253-1256. 16. Hawrylyshyn P, Bernstein P, Milligan JE, et al: Premature rupture of membranes: The role of C-reactive protein in the prediction of chorioamnionitis . Am J Obstet Gynecol 1983;147:240-246. 17. Schentag JJ, O'Keiffe D, Marmion M, et al: C-reactive protein as an indicator of infection relapse in patients with abdominal sepsis . Arch Surg 1984;119:300-304.Crossref 18. Morley JJ, Kushner I: Serum C-reactive protein levels in disease . Ann NY Acad Sci 1982;389:406-418.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

C-Reactive Protein Levels Predict Postoperative Septic Complications

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400130075011
Publisher site
See Article on Publisher Site

Abstract

Abstract • We studied 108 patients undergoing clean-contaminated and dirty surgical procedures to determine whether daily C-reactive protein (CRP) measurements for 14 days postoperatively could predict the occurrence of septic complications prior to clinical diagnosis. Diagnostic criteria for septic complications and positive CRP response were defined in advance of the study. The CRP assays were carried out using an automated laser nephelometer system after the patient's discharge from the hospital. Forty-six septic complications were diagnosed in 40 patients. These complications consisted of wound infection (23), urinary tract infection (11), pneumonia (six), upper respiratory tract infection (three), intra-abdominal abscess (one), and other (two). The CRP testing was found to have a positive predictive value of 69% and a negative predictive value of 78%. We conclude that serial CRP measurements may be a valuable adjunct to surgical care in patients at high risk of postoperative septic complications. (Arch Surg 1987;122:69-73) References 1. Pitcher WD, Musher DM: Critical importance of early diagnosis and treatment of intra-abdominal infection . Arch Surg 1982;117:328-333.Crossref 2. Dinarello CA: Interleukin 1 and the pathogenesis of the acute-phase response . N Engl J Med 1984;311:1413-1418.Crossref 3. Altemeier WA, Burke JF, Pruitt BA, et al: Manual on Control of Infections in Surgical Patients . Philadelphia, JB Lippincott Co, 1976. 4. Algorithms for diagnosing infections: Appendix E . Am J Epidemiol 1980;111:635-643. 5. Harmoinen A, Hallstrom O, Gronroos P: Rapid quantitative determination of C-reactive protein using laser-nephelometer . Scand J Clin Lab Invest 1980;40:293-295.Crossref 6. Haynes RB: How to read clinical journals: II. To learn about a diagnostic test . Can Med Assoc J 1981;124:703-710. 7. Abernathy TJ, Avery OT: The occurrence during acute infections of a protein not normally present in the blood: I. Distribution of the reactive protein in patients' sera and the effect of calcium on the flocculation reaction with the C-polysaccharide of the pneumococcus . J Exp Med 1941;73:173-181.Crossref 8. Gewurz J, Mold C, Siegel J, et al: C-reactive protein and the acute phase response . Adv Med 1982;27:345-373. 9. Kusherner I, Broder ML, Karp D: Control of the acute phase response: Serum C-reactive protein kinetics after acute myocardial infarction . J Clin Invest 1978;61:235-242.Crossref 10. Werner M: Serum protein changes during the acute phase reaction . Clin Chim Acta 1969;25:299-305.Crossref 11. Fischer CL, Gill C, Forrester MG, Nakamura R: Quantitation of acute-phase proteins' postoperatively: Value in detection and monitoring of complications. Am J Clin Pathol 1976;66:840-846. 12. Peltola HO: C-reactive protein for rapid monitoring of infections of the central nervous system . Lancet 1982;1:980-983.Crossref 13. Sabel KG, Hanson LA: The clinical usefulness of C-reactive protein determinations in bacterial meningitis and septicemia in infancy . Acta Paediatr Scand 1974;63:381-388.Crossref 14. Becker GJ, Waldburger M, Hughes GRV, et al: Value of C-reactive measurement in the investigation of fever in systemic lupus erythematosus . Ann Rheum Dis 1980;35:50-52.Crossref 15. Mackie PH, Crockson RA, Stuart J: C-reactive protein for rapid diagnosis of infection in leukemia . J Clin Pathol 1979;32;1253-1256. 16. Hawrylyshyn P, Bernstein P, Milligan JE, et al: Premature rupture of membranes: The role of C-reactive protein in the prediction of chorioamnionitis . Am J Obstet Gynecol 1983;147:240-246. 17. Schentag JJ, O'Keiffe D, Marmion M, et al: C-reactive protein as an indicator of infection relapse in patients with abdominal sepsis . Arch Surg 1984;119:300-304.Crossref 18. Morley JJ, Kushner I: Serum C-reactive protein levels in disease . Ann NY Acad Sci 1982;389:406-418.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1987

References