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Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after gastroesophageal cancer surgery

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Abstract

Purpose

This study assessed the diagnostic accuracy of C-reactive protein (CRP) after gastroesophageal cancer resection for postoperative inflammatory complications (PIC).

Methods

The clinical data and CRP values of patients operated on for gastroesophageal cancer surgery between 1997 and 2009 were retrospectively analyzed. The results of this study were compared with published data using a meta-analytic approach for diagnostic outcomes.

Results

Of 210 patients included in the study, 59 developed PIC (28.1 %; 95 % CI: 22.5–34.5 %). On the postoperative day (POD) 4 and 7, CRP had the best diagnostic accuracy for PIC (AUC 0.77; 95 % CI, 0.64–0.91, AUC 0.81; 95 % CI, 0.71–0.91). Using a cut-off value of 141 mg/L (95 % CI, 131–278 mg/L) for CRP on POD 4, the sensitivity was 0.78 (95 % CI, 0.55–0.91), the specificity was 0.70 (95 % CI, 0.53–0.83) and the NPV was 0.89 (95 % CI, 0.77–0.95). The in-hospital mortality rate was 3.3 % (95 % CI, 1.5–6.9 %). In a diagnostic meta-analysis that included two additional studies, CRP had a significant predictive value after POD 3.

Conclusion

There is limited evidence for the diagnostic accuracy of CRP levels for PIC after gastroesophageal cancer surgery. CRP levels on POD 4 might be useful to rule out PIC, but its diagnostic accuracy is moderate at best. For clinical routine use CRP levels are clearly not sufficient to predict PIC and have to be interpreted in the context of the whole clinical picture.

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References

  1. Wang D, Kong Y, Zhong B, Zhou X, Zhou Y (2010) Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg 14:620–627

    Article  PubMed  Google Scholar 

  2. Etoh T, Inomata M, Shiraishi N, Kitano S (2010) Revisional surgery after gastrectomy for gastric cancer: review of the literature. Surg Laparosc Endosc Percutan Tech 20:332–337

    Article  PubMed  Google Scholar 

  3. Farran L, Llop J, Sans M, Kreisler E, Miro M, Galan M, Rafecas A (2008) Efficacy of enteral decontamination in the prevention of anastomotic dehiscence and pulmonary infection in esophagogastric surgery. Dis Esophagus 21:159–164

    Article  PubMed  CAS  Google Scholar 

  4. Rudiger SJ, Feith M, Werner M, Stein HJ (2000) Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 232:353–361

    Article  Google Scholar 

  5. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377

    Article  PubMed  CAS  Google Scholar 

  6. Puskarich MA, Marchick MR, Kline JA, Steuerwald MT, Jones AE (2009) One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. Crit Care 13:R167

    Article  PubMed  Google Scholar 

  7. Rivers EP (2010) Point: adherence to early goal-directed therapy: does it really matter? Yes. After a decade, the scientific proof speaks for itself. Chest 138:476–480

    Article  PubMed  Google Scholar 

  8. Moller MH, Shah K, Bendix J, Jensen AG, Zimmermann-Nielsen E, Adamsen S, Moller AM (2009) Risk factors in patients surgically treated for peptic ulcer perforation. Scand J Gastroenterol 44(145–52):2

    Google Scholar 

  9. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J (2004) Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 39:206–217

    Article  PubMed  CAS  Google Scholar 

  10. Deitmar S, Anthoni C, Palmes D, Haier J, Senninger N, Bruwer M (2009) Are leukocytes and CRP early indicators for anastomotic leakage after esophageal resection? Zentralbl Chir 134:83–89

    Article  PubMed  CAS  Google Scholar 

  11. Dutta S, Fullarton GM, Forshaw MJ, Horgan PG, McMillan DC (2011) Persistent elevation of C-reactive protein following esophagogastric cancer resection as a predictor of postoperative surgical site infectious complications. World J Surg 35:1017–1025

    Article  PubMed  Google Scholar 

  12. Montagnana M, Minicozzi AM, Salvagno GL, Danese E, Cordiano C, De Manzoni G, Guidi GC, Lippi G (2009) Postoperative variation of C-reactive protein and procalcitonin in patients with gastrointestinal cancer. Clin Lab 55:187–192

    PubMed  CAS  Google Scholar 

  13. Tetteroo GW, Wagenvoort JH, Castelein A, Tilanus HW, Ince C, Bruining HA (1990) Selective decontamination to reduce gram-negative colonisation and infections after oesophageal resection. Lancet 335:704–707

    Article  PubMed  CAS  Google Scholar 

  14. Naf F, Warschkow R, Kolb W, Zund M, Lange J, Steffen T (2010) Selective decontamination of the gastrointestinal tract in patients undergoing esophageal resection. BMC Surg 10:36

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  16. Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85:1457–1459

    Article  PubMed  CAS  Google Scholar 

  17. Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36

    PubMed  CAS  Google Scholar 

  18. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  PubMed  CAS  Google Scholar 

  19. DiCiccio TJ, Efron B (1996) Bootstrap confidence intervals. Stat Sci 11:189–212

    Article  Google Scholar 

  20. Janes H, Pepe MS (2008) Adjusting for covariates in studies of diagnostic, screening, or prognostic markers: an old concept in a new setting. Am J Epidemiol 168:89–97

    Article  PubMed  Google Scholar 

  21. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  PubMed  CAS  Google Scholar 

  22. Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56:1129–1135

    Article  PubMed  Google Scholar 

  23. Schardey HM, Joosten U, Finke U, Staubach KH, Schauer R, Heiss A, Kooistra A, Rau HG, Nibler R, Ludeling S, Unertl K, Ruckdeschel G, Exner H, Schildberg FW (1997) The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial. Ann Surg 225:172–180

    Article  PubMed  CAS  Google Scholar 

  24. Pepys MB, Hirschfield GM (2003) C-reactive protein: a critical update. J Clin Invest 111:1805–1812

    PubMed  CAS  Google Scholar 

  25. Mackay GJ, Molloy RG, O'Dwyer PJ (2011) C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection. Colorectal Dis 13:583–587

    Article  PubMed  CAS  Google Scholar 

  26. Sponholz C, Sakr Y, Reinhart K, Brunkhorst F (2006) Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Crit Care 10:R145

    Article  PubMed  Google Scholar 

  27. Ito S, Sato N, Kojika M, Yaegashi Y, Suzuki Y, Suzuki K, Endo S (2005) Serum procalcitonin levels are elevated in esophageal cancer patients with postoperative infectious complications. Eur Surg Res 37:22–28

    Article  PubMed  CAS  Google Scholar 

  28. Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, Celard M, Vandenesch F, Rousson R, Lehot JJ (2000) Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med 28:3171–3176

    Article  PubMed  CAS  Google Scholar 

  29. Tang BM, Eslick GD, Craig JC, McLean AS (2007) Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 7:210–217

    Article  PubMed  CAS  Google Scholar 

  30. Szczepanik AM, Scislo L, Scully T, Walewska E, Siedlar M, Kolodziejczyk P, Lenart M, Rutkowska M, Galas A, Czupryna A, Kulig J (2011) IL-6 serum levels predict postoperative morbidity in gastric cancer patients. Gastric Cancer 14:266–273

    Article  PubMed  CAS  Google Scholar 

  31. Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, Moutardier V, Blache JL (2005) Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth 94:767–773

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Rene Warschkow, Ignazio Tarantino, Kristjan Ukegjini, Ulrich Beutner, Sascha A. Müller, Bruno M. Schmied & Thomas Steffen

  2. Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany

    Rene Warschkow

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  1. Rene Warschkow
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  2. Ignazio Tarantino
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  3. Kristjan Ukegjini
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  4. Ulrich Beutner
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  7. Thomas Steffen
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Correspondence to Rene Warschkow.

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Warschkow, R., Tarantino, I., Ukegjini, K. et al. Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after gastroesophageal cancer surgery. Langenbecks Arch Surg 397, 727–736 (2012). https://doi.org/10.1007/s00423-012-0944-6

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  • DOI: https://doi.org/10.1007/s00423-012-0944-6

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