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Erschienen in: Obesity Surgery 12/2017

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.
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Literatur
1.
Zurück zum Zitat Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240–5.CrossRefPubMed Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240–5.CrossRefPubMed
2.
Zurück zum Zitat Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch. Surg. 2016;1–10. Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch. Surg. 2016;1–10.
3.
Zurück zum Zitat Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257:231–7.CrossRefPubMed Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257:231–7.CrossRefPubMed
4.
Zurück zum Zitat Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.CrossRefPubMed Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.CrossRefPubMed
5.
Zurück zum Zitat Elliott JA, Patel VM, Kirresh A, et al. Fast-track laparoscopic bariatric surgery: a systematic review. Updat Surg. 2013;65:85–94.CrossRef Elliott JA, Patel VM, Kirresh A, et al. Fast-track laparoscopic bariatric surgery: a systematic review. Updat Surg. 2013;65:85–94.CrossRef
6.
Zurück zum Zitat Gans SL, Atema JJ, van Dieren S, et al. Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis. Int J Color Dis. 2015;30:861–73.CrossRef Gans SL, Atema JJ, van Dieren S, et al. Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis. Int J Color Dis. 2015;30:861–73.CrossRef
7.
Zurück zum Zitat Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20:13904–10.CrossRefPubMedPubMedCentral Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20:13904–10.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Albanopoulos K, Alevizos L, Natoudi M, et al. C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc. 2013;27:864–71.CrossRefPubMed Albanopoulos K, Alevizos L, Natoudi M, et al. C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc. 2013;27:864–71.CrossRefPubMed
9.
Zurück zum Zitat Muñoz JL, Ruiz-Tovar J, Miranda E, et al. C-reactive protein and Procalcitonin as early markers of septic complications after laparoscopic sleeve gastrectomy in morbidly obese patients within an enhanced recovery after surgery program. J Am Coll Surg. 2016;222:831–7.CrossRefPubMed Muñoz JL, Ruiz-Tovar J, Miranda E, et al. C-reactive protein and Procalcitonin as early markers of septic complications after laparoscopic sleeve gastrectomy in morbidly obese patients within an enhanced recovery after surgery program. J Am Coll Surg. 2016;222:831–7.CrossRefPubMed
10.
Zurück zum Zitat Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527.CrossRefPubMedPubMedCentral Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Sackett DL. Evidence-based medicine: how to practice and teach EBM. 2nd ed: Aufl. Edinburgh, Churchill Livingstone; 2001. Sackett DL. Evidence-based medicine: how to practice and teach EBM. 2nd ed: Aufl. Edinburgh, Churchill Livingstone; 2001.
13.
Zurück zum Zitat Grimes DA, Schulz KF. Refining clinical diagnosis with likelihood ratios. Lancet Lond Engl. 2005;365:1500–5.CrossRef Grimes DA, Schulz KF. Refining clinical diagnosis with likelihood ratios. Lancet Lond Engl. 2005;365:1500–5.CrossRef
15.
Zurück zum Zitat Adamina M, Steffen T, Tarantino I, et al. Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery. Br J Surg. 2015;102:590–8.CrossRefPubMed Adamina M, Steffen T, Tarantino I, et al. Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery. Br J Surg. 2015;102:590–8.CrossRefPubMed
16.
Zurück zum Zitat MacKay GJ, Molloy RG, O’Dwyer PJ. C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection. Colorectal dis. Off J Assoc Coloproctology G B Irel. 2011;13:583–7. MacKay GJ, Molloy RG, O’Dwyer PJ. C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection. Colorectal dis. Off J Assoc Coloproctology G B Irel. 2011;13:583–7.
18.
Zurück zum Zitat Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery. 2015;157:362–80. Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery. 2015;157:362–80.
19.
Zurück zum Zitat Welsch T, Müller SA, Ulrich A, Kischlat A, Hinz U, Kienle P, et al. C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis. 2007;22:1499–507. Welsch T, Müller SA, Ulrich A, Kischlat A, Hinz U, Kienle P, et al. C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis. 2007;22:1499–507.
20.
Zurück zum Zitat van der Meer W, Pickkers P, Scott CS, van der Hoeven JG, Gunnewiek JK. Hematological indices, inflammatory markers and neutrophil CD64 expression: comparative trends during experimental human endotoxemia. J Endotoxin Res. 2007;13:94–100. van der Meer W, Pickkers P, Scott CS, van der Hoeven JG, Gunnewiek JK. Hematological indices, inflammatory markers and neutrophil CD64 expression: comparative trends during experimental human endotoxemia. J Endotoxin Res. 2007;13:94–100.
21.
Zurück zum Zitat Brenner H, Gefeller O. Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence. Stat Med. 1997;16:981–91. Brenner H, Gefeller O. Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence. Stat Med. 1997;16:981–91.
22.
Zurück zum Zitat Montravers P, Augustin P, Zappella N, Dufour G, Arapis K, Chosidow D, et al. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery. Anaesth Crit Care Pain Med. 2015;34:45–52 Montravers P, Augustin P, Zappella N, Dufour G, Arapis K, Chosidow D, et al. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery. Anaesth Crit Care Pain Med. 2015;34:45–52
23.
Zurück zum Zitat Zhou XH. Effect of verification bias on positive and negative predictive values. Stat Med. 1994;13:1737–45. Zhou XH. Effect of verification bias on positive and negative predictive values. Stat Med. 1994;13:1737–45.
Metadaten
Titel
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
Publikationsdatum
07.06.2017
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 12/2017
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2744-0

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