Erschienen in:
07.06.2017 | Original Contributions
Diagnostic Performance of C-Reactive Protein in Detecting Post-Operative Infectious Complications After Laparoscopic Sleeve Gastrectomy
verfasst von:
Fadia Dib, Lara Ribeiro Parenti, Anne Boutten, David Hajage, Jean-Pierre Marmuse
Erschienen in:
Obesity Surgery
|
Ausgabe 12/2017
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Abstract
Background
Gastric leak is the most common and dreaded post-operative infectious complication (PIC) after laparoscopic sleeve gastrectomy (LSG). Accurate identification of patients at risk postoperatively is of cardinal importance.
Objective
The aim of this study is to assess the diagnostic performance of C-reactive protein (CRP) in predicting PICs and the most optimal time to measure it.
Methods
CRP results were collected in patients undergoing LSG between 2011 and 2015. CRP was systematically measured on post-operative days (POD) 1, 3, and 5.
Results
Of 1326 patients, 42 (3.2%) developed a PIC at a median of 5 days after surgery. The incidence of leakage was 1.9%. The best area under the curve was observed on POD5 (0.87; 95% CI 0.77–0.96). At this time point, a cut-off of 115 mg/L yielded a sensitivity of 66.7% (95% CI 46.5–86.8%), a specificity of 95.1% (95% CI 93.9–96.3%), a positive and negative predictive values of 19.4% (95% CI 10.3–28.6%) and 99.4% (95% CI 99.0–100%), respectively, and a positive and negative likelihood ratios (LRs) of 13.62 and 0.35, respectively. The combination of sequential assessments of CRP on POD3 and 5 provided a sensitivity of 84.4% (95% CI 71.8–97.0%), a specificity of 91.1% (95% CI 89.5–92.8%), a positive and negative predictive values of 20.9% (95% CI 14.0–27.9%) and 99.5% (95% CI 99.1–99.9%), respectively, and a positive and a negative LRs of 9.58 and 0.17, respectively.
Conclusions
CRP may be useful to identify patients at risk of PICs after LSG and, therefore, to prompt early investigation. However, CRP does not help rule out PICs.