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Diagnostic Value of C-Reactive Protein Levels in Postoperative Infectious Complications After Bariatric Surgery: a Systematic Review and Meta-Analysis

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Abstract

Background

Bariatric surgery involves the risk of postoperative infectious complications, in particular, anastomotic leaks and intra-abdominal abscesses. C-reactive protein (CRP) is a nonspecific marker of inflammation which has gained attention as a test to predict postoperative infectious complications. This systematic review and meta-analysis evaluated the diagnostic value of CRP to detect postoperative infectious complications after bariatric surgery.

Methods

Search of MEDLINE, EMBASE, CENTRAL, and PubMed databases were performed. Articles measuring serum CRP postoperatively in patients with obesity undergoing bariatric surgery were included. Main outcomes included diagnostic value of postoperative serum CRP (area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV)). Diagnostic accuracy of included studies was assessed using QUADAS-2.

Results

Six studies including 2770 patients met the inclusion criteria. The derived CRP cutoff values were 71.4 mg/dL, 130.3 mg/dL, and 118.7 mg/dL on postoperative days (PODs) 1, 3, and 5, respectively. Pooled AUC was similar across PODs 1, 3, and 5 with AUC being highest on POD 5 (0.88 ± 0.07). PPV was between 19 and 21%, and NPV was between 98 and 99%. CRP levels were significantly higher (P < .0001) in postoperative infectious complication group versus the no complication group on PODs 3 and 5.

Conclusions

High NPV and moderately high sensitivity on PODs 1, 3, and 5 may help predict patients who are at a low risk of infectious complication following bariatric surgery. High specificity on PODs 1 and 3 also indicates that it can be useful for early diagnosis of postoperative infectious complications.

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Acknowledgements

We thank Andrea McLellan, an expert medical librarian, for her assistance with the literature search strategy development.

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Authors and Affiliations

  1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

    Yung Lee & Tyler McKechnie

  2. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada

    Yung Lee, Tyler McKechnie, Aristithes G. Doumouras, Cagla Eskicioglu, Scott Gmora, Mehran Anvari & Dennis Hong

  3. Division of General Surgery, Department of Surgery, St. Joseph Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada

    Aristithes G. Doumouras, Chovav Handler, Cagla Eskicioglu, Scott Gmora, Mehran Anvari & Dennis Hong

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  1. Yung Lee
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Correspondence to Dennis Hong.

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Yung Lee and Tyler McKechnie are joint first authors

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Appendix. Complete search strategy

Appendix. Complete search strategy

1 exp bariatric surgery/

2 bariatric*.mp.

3 gastroplast*.mp.

4 ((gastric or jejunoileal or jejuno-ileal or ileojejunal or ileo jejunal or gastroileal or roux-en-y) adj2bypass*).mp.

5 gastrojejunostom*.mp.

6 intestinal bypass*.mp.

7 lipectomy/

8 lipectom*.mp.

9 lipoplasty/

10 lipoplast*.mp.

11 lipolysis/

12 lipolysis.mp.

13 liposuction/

14 liposuction*.mp.

15 gastric band*.mp.

16 biliopancreatic bypass/

17 bilio-pancreatic diversion.mp.

18 biliopancreatic diversion*.mp.

19 exp gastrectomy/

20 gastrectom*.mp.

21 duodenal switch.mp.

22 gastric plication.mp.

23 gastric placation.mp.

24 gastric balloon/

25 gastric bubble*.mp.

26 ballobes balloon*.mp.

27 duodenal ileostomy.mp.

28 or/1-27

29 exp C-Reactive Protein/

30 CRP.mp.

31 C Reactive Protein.mp.

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Lee, Y., McKechnie, T., Doumouras, A.G. et al. Diagnostic Value of C-Reactive Protein Levels in Postoperative Infectious Complications After Bariatric Surgery: a Systematic Review and Meta-Analysis. OBES SURG 29, 2022–2029 (2019). https://doi.org/10.1007/s11695-019-03832-5

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  • DOI: https://doi.org/10.1007/s11695-019-03832-5

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