Abstract
Postoperative C-reactive protein (CRP) level allows to rule out infectious complications ensuring safe hospital discharge in colorectal cancer surgery. Since its clinical significance in Crohn’s disease (CD) has not been studied yet, we investigated whether CRP can guide decision-making on hospital discharge in this population. Only consecutive CD patients undergoing resections with primary anastomosis and without covering stoma (2013–2017) were analysed. Pre- and post-operative CRP values, measured daily until discharge, were correlated with postoperative complications including anastomotic leakage (AL), infectious and non-infectious complications. The diagnostic accuracy of CRP in predicting AL was evaluated according to the area under the curve (AUC), using the receiver-operating characteristic (ROC) methodology. Two-hundred and fifty-one consecutive patients undergoing elective surgery for CD were selected. AL was diagnosed in 10 patients (4%). High CRP level was associated with AL on postoperative day (POD) 3–5 (p = 0.002, AUC 0.825) with a positive predictive value of 60%. CRP linear difference of 140 between POD 1 and 3 (AUC 0.800) maximizes sensitivity and specificity with a NPV of 98.6%. CRP trend, measured with the linear difference between POD 1 and 3, is able to rule out anastomotic complications with a high NPV and may allow a safe early hospital discharge after surgery for CD.
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References
Spinelli A, Bazzi P, Sacchi M et al (2013) Short-term outcomes of laparoscopy combined with enhanced recovery pathway after ileocecal resection for crohn’s disease: a case-matched analysis. J Gastrointest Surg. https://doi.org/10.1007/s11605-012-2012-5
Mineccia M, Menonna F, Germani P et al (2020) A retrospective study on efficacy of the ERAS protocol in patients undergoing surgery for Crohn’s disease: a propensity score analysis. Dig Liver Dis. https://doi.org/10.1016/j.dld.2020.01.006
Garcia-Granero A, Frasson M, Flor-Lorente B et al (2013) Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum 56:475–483. https://doi.org/10.1097/DCR.0b013e31826ce825
Hyman N, Manchester TL, Osler T et al (2007) Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg 245:254–258. https://doi.org/10.1097/01.sla.0000225083.27182.85
Waterland P, Ng J, Jones A et al (2016) Using CRP to predict anastomotic leakage after open and laparoscopic colorectal surgery: is there a difference? Int J Colorectal Dis 31:861–868. https://doi.org/10.1007/s00384-016-2547-0
Welsch T, Müller SA, Ulrich A et al (2007) C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis 22:1499–1507. https://doi.org/10.1007/s00384-007-0354-3
Almeida AB, Faria G, Moreira H et al (2012) Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery. Int J Surg 10:87–91. https://doi.org/10.1016/j.ijsu.2011.12.006
Smith SR, Pockney P, Holmes R et al (2018) Biomarkers and anastomotic leakage in colorectal surgery: C-reactive protein trajectory is the gold standard. ANZ J Surg. https://doi.org/10.1111/ans.13937
de Buck van Overstraeten A, Van Hoef S, Vermeire S, Ferrante M, Fieuws S, Wolthuis A, Van Assche G, D’Hoore A (2015) Postoperative inflammatory response in Crohn’s patients: a comparative study. J Crohn's Colitis 9:1127–1131
Li Y, Zuo L, Zhu W et al (2015) The impact of bacterial DNA translocation on early postoperative outcomes in Crohn’s patients undergoing abdominal surgery. J Crohns Colitis. https://doi.org/10.1093/ecco-jcc/jju029
Wolthuis AM, Penninckx F, Fieuws S, D’Hoore A (2012) Outcomes for case-matched single-port colectomy are comparable with conventional laparoscopic colectomy. Color Dis 14:634–641. https://doi.org/10.1111/j.1463-1318.2011.02721.x
MacFie J, Reddy BS, Gatt M et al (2006) Bacterial translocation studied in 927 patients over 13 years. Br J Surg. https://doi.org/10.1002/bjs.5184
Galata C, Kienle P, Weiss C et al (2019) Risk factors for early postoperative complications in patients with Crohn’s disease after colorectal surgery other than ileocecal resection or right hemicolectomy. Int J Colorectal Dis. https://doi.org/10.1007/s00384-018-3196-2
Reynolds IS, Boland MR, Reilly F et al (2017) C-reactive protein as a predictor of anastomotic leak in the first week after anterior resection for rectal cancer. Color Dis. https://doi.org/10.1111/codi.13649
Singh PP, Zeng ISL, Srinivasa S et al (2014) Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. https://doi.org/10.1002/bjs.9354
Mackay GJ, Molloy RG, O’Dwyer PJ (2011) C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection. Color Dis. https://doi.org/10.1111/j.1463-1318.2010.02236.x
Adamina M, Steffen T, Tarantino I et al (2015) Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery. Br J Surg. https://doi.org/10.1002/bjs.9756
Gans SL, Atema JJ, van Dieren S et al (2015) Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis. Int J Colorectal Dis. https://doi.org/10.1007/s00384-015-2205-y
Warschkow R, Beutner U, Steffen T et al (2012) Safe and early discharge after colorectal surgery due to C-reactive protein. Ann Surg. https://doi.org/10.1097/sla.0b013e31825b60f0
Grandt SD, El-Hussuna A, Frasson M, Singh B, Gallo G, Pata F, Negoi I, Pinkney T, Zmora O, Bhangu A, Battersby N (2019) Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate. World J Gastrointest Surg. https://doi.org/10.4240/wjgs.v11.i5.261
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MC and AS conceived the study. FC AM MG performed data collection and analysis. MC wrote the manuscript; AS, GF, MC and SD, critically revised the article. No specific funding has been received to perform this study.
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MC, AM, FC, GF, MG and MC have no conflict of interest. AS has acted as consultant or speaker for Ethicon, Olympus, Frankenman, Tigenyx, Pfizer, Takeda, Sandoz. SD has served as speaker, consultant and advisory board member for Abbvie, Ferring, Hospira, Johnson and Johnson, Merck, MSD, Takeda, Mundipharma, Pfizer Inc, Tigenix, UCB Pharma, Vifor, Biogen, Celgene, Allergan, Celltrion, Sandoz, Boehringer Ingelheim.
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Carvello, M., Di Candido, F., Greco, M. et al. The trend of C-Reactive protein allows a safe early discharge after surgery for Crohn’s disease. Updates Surg 72, 985–989 (2020). https://doi.org/10.1007/s13304-020-00789-4
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DOI: https://doi.org/10.1007/s13304-020-00789-4