Skip to main content
SpringerLink
Log in

Diagnostic Performance of C-Reactive Protein in Detecting Post-Operative Infectious Complications After Laparoscopic Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Gastric leak is the most common and dreaded post-operative infectious complication (PIC) after laparoscopic sleeve gastrectomy (LSG). Accurate identification of patients 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 measured 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 positive 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%), respectively, and a positive and a negative LRs of 9.58 and 0.17, respectively.

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240–5.

    Article  PubMed  Google Scholar 

  2. Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch. Surg. 2016;1–10.

  3. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257:231–7.

    Article  PubMed  Google Scholar 

  4. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.

    Article  PubMed  Google Scholar 

  5. Elliott JA, Patel VM, Kirresh A, et al. Fast-track laparoscopic bariatric surgery: a systematic review. Updat Surg. 2013;65:85–94.

    Article  Google Scholar 

  6. Gans SL, Atema JJ, van Dieren S, et al. Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis. Int J Color Dis. 2015;30:861–73.

    Article  Google Scholar 

  7. Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20:13904–10.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Albanopoulos K, Alevizos L, Natoudi M, et al. C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc. 2013;27:864–71.

    Article  PubMed  Google Scholar 

  9. Muñoz JL, Ruiz-Tovar J, Miranda E, et al. C-reactive protein and Procalcitonin as early markers of septic complications after laparoscopic sleeve gastrectomy in morbidly obese patients within an enhanced recovery after surgery program. J Am Coll Surg. 2016;222:831–7.

    Article  PubMed  Google Scholar 

  10. Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–5.

    Article  CAS  PubMed  Google Scholar 

  12. Sackett DL. Evidence-based medicine: how to practice and teach EBM. 2nd ed: Aufl. Edinburgh, Churchill Livingstone; 2001.

  13. Grimes DA, Schulz KF. Refining clinical diagnosis with likelihood ratios. Lancet Lond Engl. 2005;365:1500–5.

    Article  Google Scholar 

  14. Straatman J, Harmsen AMK, Cuesta MA, Berkhof J, Jansma EP, van der Peet DL. Predictive value of C-reactive protein for major complications after major abdominal surgery: a systematic review and pooled-analysis. PLoS ONE [Internet]. 2015 [cited 2016 May 10];10. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4503561/.

  15. Adamina M, Steffen T, Tarantino I, et al. Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery. Br J Surg. 2015;102:590–8.

    Article  CAS  PubMed  Google Scholar 

  16. MacKay GJ, Molloy RG, O’Dwyer PJ. C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection. Colorectal dis. Off J Assoc Coloproctology G B Irel. 2011;13:583–7.

    CAS  Google Scholar 

  17. Straatman J, van der Peet DL. C-reactive protein after major abdominal surgery: biochemical and clinical aspects. ResearchGate [Internet]. 2015 [cited 2016 Sep 21];2. Available from: https://www.researchgate.net/publication/279212476_C-reactive_protein_after_major_abdominal_surgery_biochemical_and_clinical_aspects.

  18. Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery. 2015;157:362–80.

  19. Welsch T, Müller SA, Ulrich A, Kischlat A, Hinz U, Kienle P, et al. C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis. 2007;22:1499–507.

  20. van der Meer W, Pickkers P, Scott CS, van der Hoeven JG, Gunnewiek JK. Hematological indices, inflammatory markers and neutrophil CD64 expression: comparative trends during experimental human endotoxemia. J Endotoxin Res. 2007;13:94–100.

  21. Brenner H, Gefeller O. Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence. Stat Med. 1997;16:981–91.

  22. Montravers P, Augustin P, Zappella N, Dufour G, Arapis K, Chosidow D, et al. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery. Anaesth Crit Care Pain Med. 2015;34:45–52

  23. Zhou XH. Effect of verification bias on positive and negative predictive values. Stat Med. 1994;13:1737–45.

Download references

Acknowledgements

We extend our gratitude to Dr. Damien Van Gysel who provided data on length of hospital stay and Mr. Arnaud Serret Larmande for proofreading the final draft of the manuscript.

Author information

Authors and Affiliations

  1. AP-HP, Department of Epidemiology, Biostatistics and Clinical Research, Bichat-Claude-Bernard Hospital, Paris Diderot University, 46, rue Henri-Huchard, 75018, Paris, France

    Fadia Dib

  2. INSERM, CIC-EC 1425, 75018, Paris, France

    Fadia Dib

  3. AP-HP, General Surgery, Department of Surgery, Bichat-Claude-Bernard Hospital, Paris, France

    Lara Ribeiro Parenti & Jean-Pierre Marmuse

  4. AP-HP, Department of Biochemistry, Bichat-Claude-Bernard Hospital, Paris, France

    Anne Boutten

  5. Département de Biostatistiques, Santé publique et Information médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France

    David Hajage

  6. Sorbonne Paris Cité, UMR 1123 ECEVE, Université Paris Diderot, 75010, Paris, France

    David Hajage

  7. INSERM, UMR 1123 ECEVE, 75018, Paris, France

    David Hajage

Authors
  1. Fadia Dib
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lara Ribeiro Parenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne Boutten
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Hajage
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean-Pierre Marmuse
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: Marmuse, Dib.

Acquisition of data: Marmuse.

Analysis and interpretation of data: Marmuse, Dib.

Drafting of manuscript: Dib.

Critical revision: Hajage, Ribiero Parenti, Boutten.

Corresponding author

Correspondence to Fadia Dib.

Ethics declarations

Funding

The authors received no specific funding for this work.

Ethics Statement

This research was conducted according to French Ethics law (Loi Huriet) which does not require formal ethical approval for this kind of studies. For this type of study, formal consent is not required. The data file was declared to the French national commission for computerized files and liberty (declaration no. 1995504). This study was reported in accordance with the guidelines from the Standards for Reporting of Diagnostic Accuracy statement.

Conflict of Interest

The authors declare that they have no conflict of interest.

Electronic Supplementary Material

Appendix 1

Preoperative assessment, surgical procedure and post-operative management. (DOCX 13.6 kb)

Appendix 2

Definitions of septic complications included in the outcome of interest. (DOCX 14.9 kb)

Appendix 3

Sensitivity analysis. (DOCX 12.5 kb)

Appendix 4

Post-operative changes in C-reactive protein in patients with and without septic complications. (TIFF 1877 kb)

High resolution image (GIF 70 kb)

Appendix 5

Post-operative changes in C-reactive protein in patients with and without a simultaneous procedure. (TIFF 1877 kb)

High resolution image (GIF 96 kb)

Appendix 6

Diagnostic performance of C- reactive protein levels on post-operative days 1, 3 and 5, for the detection of infectious complications occurring within 8 days of surgery. (DOCX 16.7 kb)

Appendix 7

Diagnostic performance of C-reactive protein levels on post-operative days 1, 3 and 5, for the detection of gastric leak. (DOCX 15.2 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dib, F., Parenti, L.R., Boutten, A. et al. Diagnostic Performance of C-Reactive Protein in Detecting Post-Operative Infectious Complications After Laparoscopic Sleeve Gastrectomy. OBES SURG 27, 3124–3132 (2017). https://doi.org/10.1007/s11695-017-2744-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-2744-0

Keywords

Search

Navigation