CLINICS

Clinics (Sao Paulo). 2017 January; 72(1): 23-29.
doi:10.6061/clinics/2017(01)05

Copyright © 2017 CLINICS

Predictive value of C-reactive protein in critically ill patients after abdominal surgery

Frédéric Sapin , Patrick Biston , Michael Piagnerelli *

Université Libre de Bruxelles, Intensive Care, CHU-Charleroi, 6042-Charleroi, Belgium

*Corresponding author. E-mail: michael.piagnerelli@chu-charleroi.be

received May 25, 2016; revised September 12, 2016; accepted October 18, 2016.

Abstract

OBJECTIVES:

The development of sepsis after abdominal surgery is associated with high morbidity and mortality. Due to inflammation, it may be difficult to diagnose infection when it occurs, but measurement of C-reactive protein could facilitate this diagnosis. In the present study, we evaluated the predictive value and time course of C-reactive protein in relation to outcome in patients admitted to the intensive care unit (ICU) after abdominal surgery.

METHODS:

We included patients admitted to the ICU after abdominal surgery over a period of two years. The patients were divided into two groups according to their outcome: favorable (F; left the ICU alive, without modification of the antibiotic regimen) and unfavorable (D; death in the ICU, surgical revision with or without modification of the antibiotic regimen or just modification of the regimen). We then compared the highest C-reactive protein level on the first day of admission between the two groups.

RESULTS:

A total of 308 patients were included: 86 patients had an unfavorable outcome (group D) and 222 had a favorable outcome (group F). The groups were similar in terms of leukocytosis, neutrophilia, and platelet count. C-reactive protein was significantly higher at admission in group D and was the best predictor of an unfavorable outcome, with a sensitivity of 74% and a specificity of 72% for a threshold of 41 mg/L. No changes in C-reactive protein, as assessed based on the delta C-reactive protein, especially at days 4 and 5, were associated with a poor prognosis.

CONCLUSIONS:

A C-reactive protein cut-off of 41 mg/L during the first day of ICU admission after abdominal surgery was a predictor of an adverse outcome. However, no changes in the C-reactive protein concentration, especially by day 4 or 5, could identify patients at risk of death.

Keywords: C-reactive Protein, Biomarker, Abdominal Surgery, Outcome, Mortality, Antibiotics


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