Ann Surg Treat Res.  2019 Aug;97(2):65-73. 10.4174/astr.2019.97.2.65.

Reduction rate of C-reactive protein as an early predictor of postoperative complications and a reliable discharge indicator after gastrectomy for gastric cancer

• Lee SH
• Kim KH
• Choi CW
• Kim SJ
• Kim DH
• Choi CI
• Hwang SH

• KMID: 2455980
• DOI: http://doi.org/10.4174/astr.2019.97.2.65

Abstract

PURPOSE
Postoperative complications (PCs) after gastrectomy are associated with readmission and longer hospital stay. This study aimed to determine the role of CRP as an early predictor of PCs and a reliable discharge indicator after gastrectomy.
METHODS
Clinicopathologic data and PCs of 613 patients who underwent gastrectomy for gastric cancer in 2015-2016 were retrospectively analyzed, including consecutive blood samples for CRP obtained preoperatively, at the operative day, and postoperatively. Following the Clavien-Dindo classification, the patients were divided into a group with major PCs and a group with minor/no PCs. Diagnostic accuracy was determined by the area under the receiver operating characteristic curve (AUC). Clinical factors related to major PCs were identified using univariate and multivariate logistic regression analyses.
RESULTS
PCs occurred in 89 patients (14.5%). The most significant predictive factor for major PCs was a CRP concentration reduction rate of ≤38.1% (AUC, 0.82; sensitivity, 76.4%; specificity, 76.1%) between postoperative day (POD) 3 and 5 (R5), followed by ≤11.1% (AUC, 0.75; sensitivity, 73%; specificity, 76%) between POD 2 and 3 (R4). When both factors were applied (R4 ≤ 11.1% and R5 ≤ 38.1%), the specificity was 91.6%; when only one condition was satisfied (R4 ≤ 11.1% or R5 ≤ 38.1%), the sensitivity was 91%.
CONCLUSION
CRP concentration reduction rates between POD 3 and 5 and between POD 2 and 3 were the best combination factors to predict PCs and indicate a safe discharge after gastrectomy for gastric cancer.

Keyword

C-reactive protein; Postoperative complications; Stomach neoplasms

MeSH Terms

C-Reactive Protein*
Classification
Gastrectomy*
Humans
Length of Stay
Logistic Models
Postoperative Complications*
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Stomach Neoplasms*
C-Reactive Protein

Figure

• 

  Fig. 1 Schematic of the study protocol. The major complication group comprised patients with postoperative complications (PCs) of grade II or higher according to the Clavien-Dindo classification. Patients with PCs of grade I or without PCs were included in the minor/no complication group.

• 

  Fig. 2 Perioperative changes in CRP concentration after gastrectomy. Preop, preoperative day; Op. day, operative day; POD, postoperative day.

• 

  Fig. 3 Receiver operating characteristic (ROC) curves for the diagnostic accuracy of the CRP concentration decline rate in predicting postoperative complications. AUC, area under the curve; CI, confidence interval.

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