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
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.
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: https://dx.doi.org/10.1016/s0196-6553(96)90046-2.
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: https://dx.doi.org/10.1007/bf01705408.
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: https://dx.doi.org/10.1056/nejmoa010307.
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: https://dx.doi.org/10.1046/j.1365-2168.2002.02218.x.
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: https://dx.doi.org/10.1016/0140-6736(93)90277-n.
Hack CE, Zeerleder S. The endothelium in sepsis: Source of and a target for inflammation. Critical Care Med. 2001;29:S21– S27. Available from: https://dx.doi.org/10.1097/00003246-200107001-00011.
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: https://dx.doi.org/10.1016/j.lab.2005.08.005.
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: https://dx.doi.org/10.1111/j.1463-1318.2007.01300.x.
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: https://dx.doi.org/10.1086/421997.
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: https://dx.doi.org/10.3325/cmj.2012.53.612.
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: https://dx.doi.org/10.1016/s0140-6736(83)91704-x.
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: https://dx.doi.org/10.1159/000018625.
Copyright (c) 2020 Author
This work is licensed under a Creative Commons Attribution 4.0 International License.