Serum C-reactive protein and Pro-Calcitonin as an Indicator in Post-Operative Infection after Hepatobiliary Surgery

Indicator in Post-Operative Infection after Hepatobiliary Surgery

Keywords: Serum CRP, Serum PCT, post operative Infection, Hepato-biliary surgery


Background: Major hepato-biliary surgeries carry a high risk for post-operative sepsis. Recent therapeutic advances both medical and surgical have improved early post-operative outcome. Considering the difficulties in diagnosis of infection in critically ill patients an early sensitive  and specific marker for sepsis would be of interest. Studies have shown that C - reactive protein (CRP) and pro calcitonin (PCT) are acute phase reactants and good independent early markers of post-operative sepsis, severe or septic shock. This aspect has not been evaluated in     the hepatobiliary surgeries. More over there is no data available from the Indian sub-continent in this aspect. This study aims to evaluate the efficacy of serum CRP and PCT levels after hepatobiliary surgery for diagnosis of postoperative complication. Subjects and Methods: This is a cross-sectional diagnostic study has conducted in 42 patients who all are satisfying the inclusion criteria. Study duration was From August 2017 to July 2019, conducted on patients between 18-80yrs of age undergoing hepato-biliary surgery, in surgical wards of PK Das Institute     of Medical Sciences. Study variables include age, sex, pre-operative serum albumin level, pre and post-operative S.CRP AND S.PCT levels. On post-operative day 4 and day 7 S.CRP and S.PCT are monitored and its predictability also measured. . Descriptive statistical analysis will be carried out using SPSS (IBM). The p-value of less than 0.05 will be taken as significant. Results: out of 42 patients studied, 30 patients developed post-operative complications. Pre-operative serum C - reactive protein and serum procalcitonin measured compared with pre-operative serum albumin was significant identifying post-operative complications (P-value 0.02). On post-operative day 4 and 7value was significant in post-operative patients with P-value of 0.04 vs. 0.046 respectively. Similarly serum procalcitonin values also were significant on postoperative day (POD) 4 and 7 with P-value of 0.02 and 0.03. Sensitivity and specificity of S.PCT was more compared to S.CRP (92 vs 90% in sensitivity and 100% vs 80% in specificity respectively. This study shows those who were clinically septic post operatively have statistically elevated levels of serum CRP and Procalcitonin. Conclusion: S.PCT is more sensitive and specific as a marker of post operative infection following hepato biliary surgery. Early identification of patients with insidious septic illness allows early therapeutic intervention which may favorably influence outcome.


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Velasco E, Santosthuler L, Martins C, Decastrodias L, Dasec- conalves V. Risk factors for infectious complications after abdominal surgery for malignant disease. Am J Inf Control. 1996;24(1):1–6. Available from:

Pittet D, Rangel-Frausto S, Li N, Tarara D, Costigan M, Rempe L, et al. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: Incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med. 1995;21(4):302–309. Available from:

Rangel FS, Pittet D, Costigan M, Wang T, Davis CS, P R. The natural history of the systemic inflammatory response syndrome (SIRS): A prospective study. JAMA. 1985;273:117– 140.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. New England J Med. 2001;345(19):1368–1377. Available from:

Mokart D, Capo C, Blache JL, Delpero JR, Houvenaeghel G, Martin C, et al. Early postoperative compensatory anti- inflammatory response syndrome is associated with septic complications after major surgical trauma in patients with cancer. Br J Surg. 2002;89(11):1450–1456. Available from:

Noori NM, Shahramian I, Teimouri A, Keyvani B, Mahjoubi- fard M. Serum Levels of Tumor Necrosis Factor-α and Inter- leukins in Children with Congenital Heart Disease. J Tehran Heart Cent. 2017;12(1):15–22.

Deitmar S, Anthoni C, Palmes D. Are leukocytes and CRP early indicators for anastomotic leakage after esophageal resection. Zentralbal Chir. 2009;134:83–92.

Assicot M, Bohuon C, Gendrel D, Raymond J, Carsin H, Guilbaud J. High serum procalcitonin concentra- tions in patients with sepsis and infection. Lancet. 1993;341(8844):515–518. Available from:

Hack CE, Zeerleder S. The endothelium in sepsis: Source of and a target for inflammation. Critical Care Med. 2001;29:S21– S27. Available from:

Bota DP, Nuffelen MV, Zakariah AN, Vincent JL. Serum levels of C-reactive protein and procalcitonin in critically ill patients with cirrhosis of the liver. J Lab Clin Med. 2005;146(6):347–351. Available from:

Matthiessen P, Henriksson M, Hallböök O, Grunditz E, Norén B, Arbman G. Increase of serum C-reactive pro- tein is an early indicator of subsequent symptomatic anas-tomotic leakage after anterior resection. Colorectal Dis. 2007;0(0):070730035900001–??? Available from:

Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum Procalcitonin and C-Reactive Protein Levels as Markers of Bacterial Infection: A Systematic Review and Meta-analysis. Clin Inf Dis. 2004;39(2):206–217. Available from:

Oberhofer D, Juras J, Pavičić AM, Žurić IR, Rumenjak V. Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery. Croatian Med J. 2012;53(6):612– 619. Available from:

Mallet E, Lanse X, Devaux AM, Ensel P, Basuyau JP, Brunelle P. Hypercalcitoninaemia in fulminant meningococcaemia in children. Lancet. 1983;321(8319):294–294. Available from:

Reith HB, Mittelkötter U, Debus ES, Küssner C, Thiede A. Procalcitonin in Early Detection of Postoperative Complications. Digestive Surg. 1998;15(3):260–265. Available from: