Acute-phase changes in children recovering from minor surgery

Abstract

The metabolic response to surgical stress is a nonspecific increase in hepatic synthesis of some specialized acute-phase proteins and a decrease in plasma concentrations of visceral proteins following surgical trauma. This study was undertaken determine which specific proteins were the better clinical indices in monitoring the metabolic response to surgical stress in children recovering from minor surgery. Forty-four patients undergoing elective inguinal surgical procedures under general anesthesia were studied. Blood samples were collected preoperatively (−1) and at 1(+1) and 5(+5) days postoperatively to determine albumin (AL), Prealbumin (PA), C-reactive protein (CRP), and a₁-acid glycoprotein (AGP) values, and to calculate the prognostic inflammatory and nutritional index (PINI). Mean AL values were the same on all days. Mean PA  +1 was significantly lower than PA −1 and PA +5 (P < 0.001). Median CRP +1 and mean AGP +1 values were significantly higher than median CRP −1 and mean AGP −1 (P < 0.0001), respectively. Although there was a decrease after postoperative day 1, median CRP +5 and mean AGP +5 values were still significantly higher than preoperative values (P < 0.01 and P < 0.0001). Moreover, the median PINI +1 was also greater than PINI −1 and PINI +5 (P < 0.0001), but the median PINI+5 was significantly higher than PINI −1 (P < 0.01). Median percent changes of PINI values were significantly higher than those of the other parameters from both preoperatively to postoperative day 1 and preoperatively to postoperative day 5. Although several specific proteins (AL, PA, CRP, and AGP) have been evaluated as indicators of the acute metabolic response, we suggest that the PINI is more valuable for reflecting the response to surgical stress in patients recovering from minor surgery.