Diagnostic Performance of C-Reactive Protein in Detecting
Post-Operative Infectious Complications After Laparoscopic
Lara Ribeiro Parenti
Published online: 7 June 2017
Springer Science+Business Media New York 2017
Background Gastric leak is the most common and dreaded
post-operative infectious complication (PIC) after laparoscop-
ic sleeve gastrectomy (LSG). Accurate identification of pa-
tients at risk postoperatively is of cardinal importance.
Objective The aim of this study is to assess the diagnostic
performance of C-reactive protein (CRP) in predicting PICs
and the most optimal time to measure it.
Methods CRP results were collected in patients undergoing
LSG between 2011 and 2015. CRP was systematically mea-
sured on post-operative days (POD) 1, 3, and 5.
Results Of 1326 patients, 42 (3.2%) developed a PIC at a
median of 5 days after surgery. The incidence of leakage
was 1.9%. The best area under the curve was observed on
POD5 (0.87; 95% CI 0.77–0.96). At this time point, a cut-
off of 115 mg/L yielded a sensitivity of 66.7% (95% CI 46.5–
86.8%), a specificity of 95.1% (95% CI 93.9–96.3%), a pos-
itive and negative predictive values of 19.4% (95% CI 10.3–
28.6%) and 99.4% (95% CI 99.0–100%), respectively, and a
positive and negative likelihood ratios (LRs) of 13.62 and
0.35, respectively. The combination of sequential assessments
of CRP on POD3 and 5 provided a sensitivity of 84.4% (95%
CI 71.8–97.0%), a specificity of 91.1% (95% CI 89.5–
92.8%), a positive and negative predictive values of 20.9%
(95% CI 14.0–27.9%) and 99.5% (95% CI 99.1–99.9%), re-
spectively, and a positive and a negative LRs of 9.58 and 0.17,
Conclusions CRP may be useful to identify patients at risk of
PICs after LSG and, therefore, to prompt early investigation.
However, CRP does not help rule out PICs.
Keywords C-reactive protein
Laparoscopic sleeve gastrectomy
Laparoscopic sleeve gastrectomy (LSG) has become a first-
line treatment in bariatric surgery. It is considered as a simple
and easy procedure, yet it involves some risk of post-operative
infectious complications (PICs). Gastric leaks are the most
common and the most feared PICs after LSG . They are
the second most common cause of death after bariatric surgery
 and occur in around 2% of patients .
A significant proportion of leaks occur well after surgery.
In a systematic review of more than 4000 patients published in
2012, 79% of leaks occurred more than 10 days after surgery
and after hospital discharge . In particular, the increasing
Electronic supplementary material The online version of this article
(doi:10.1007/s11695-017-2744-0) contains supplementary material,
which is available to authorized users.
* Fadia Dib
AP-HP, Department of Epidemiology, Biostatistics and Clinical
Research, Bichat-Claude-Bernard Hospital, Paris Diderot University,
46, rue Henri-Huchard, 75018 Paris, France
INSERM, CIC-EC 1425, 75018 Paris, France
AP-HP, General Surgery, Department of Surgery,
Bichat-Claude-Bernard Hospital, Paris, France
AP-HP, Department of Biochemistry, Bichat-Claude-Bernard
Hospital, Paris, France
Département de Biostatistiques, Santé publique et Information
médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France
Sorbonne Paris Cité, UMR 1123 ECEVE, Université Paris Diderot,
75010 Paris, France
INSERM, UMR 1123 ECEVE, 75018 Paris, France
OBES SURG (2017) 27:3124–3132