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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(04): 375-382
DOI: 10.1055/s-0041-1736641
Original Article

C-Reactive Protein as a Marker of Postoperative Complication of Emergency Colorectal Surgery

Luis R. M. Nadal 
1   General and Oncologic Surgery Service, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
,
Artur M. A. da Silva 
1   General and Oncologic Surgery Service, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
,
Larissa Johann 
2   Medicine Student, Faculdade de Medicina, Universidade Cidade de São Paulo, São Paulo, São Paulo, Brazil
,
Shuaib H. El Boustani 
2   Medicine Student, Faculdade de Medicina, Universidade Cidade de São Paulo, São Paulo, São Paulo, Brazil
,
Maria Beatriz A. S. Medrado 
1   General and Oncologic Surgery Service, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
,
Jose F. M. Farah 
1   General and Oncologic Surgery Service, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
,
Renato A. Lupinacci 
1   General and Oncologic Surgery Service, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
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Abstract

Introduction The literature converges regarding the use of C-reactive protein (CRP) tests between postoperative days (PODs) 3 and 5 of elective procedures. In this period, they have great sensitivity and negative predictive value (NPV) for severe and anastomotic complications about two days before the first clinical sign. The few studies on colorectal urgency suggest that, despite the different initial values according to the surgical indication, following POD 3, the level of CRP is similar to that of elective procedures. However, given the heterogeneity of the studies, there is no consensus on the cutoff values for this use.

Objective To validate the use and propose a PO CRP cut-off value in urgent colorectal procedures as an exclusion criterion for complications of anastomosis or the abdominal cavity.

Method Retrospective analysis of the medical records of 308 patients who underwent urgent colorectal surgical procedures between January 2017 and December 2019. The following data were considered: age, gender, surgical indication, type of procedure performed, complications, CRP levels preoperatively and from POD 1 to 4, and the severity of the complications. We compared the CRP levels and the percentage variations between the preoperative period and PODs 1 to 4 as markers of severe complications using the receiver operating characteristic (ROC) curve.

Results The levels of CRP on POD4, and their percentage drops between PODs 2 to 4 and PODs 3 to 4, were better to predict severe complications. A cutoff of 7.45 mg/dL on POD 4 had 91.7% of sensitivity and NPV. A 50% drop between PODs 3 and 4 had 100% of sensitivity and NPV.

Conclusion Determining the level of CRP is useful to exclude severe complications, and it could be a criterion for hospital discharge in POD 4 of emergency colorectal surgery.

Keywords

colorectal surgery - C-reactive protein - postoperative complications - acute surgery

In this manuscript, we show the use of C-reactive protein (CRP) as a tool to exclude severe postoperative complications of urgent colon and rectal surgery, allowing a safe early discharge, as it is currently used in elective procedures. To our knowledge, this is the first study concerning a formal cut-off for CRP and this use of CRP variation in emergency colorectal surgery.




Publication History

Received: 20 January 2021

Accepted: 15 June 2021

Article published online:
13 December 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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