Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery

BackgroundThe aim of this analysis was to assess the predictive value of C-reactive protein (CRP) for the early detection of postoperative infectious complications after a variety of abdominal operations. MethodsA meta-analysis of seven cohort studies from a single institution was performed. Laparoscopic gastric bypass and colectomies, as well as open resections of cancer of the colon, rectum, pancreas, stomach and oesophagus, were included. The predictive value of CRP was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. ResultsOf 1986 patients, 577 (291 (95 per cent c.i. 271 to 313) per cent) had at least one postoperative infectious complication. Patients undergoing laparoscopic gastric bypass (383 patients) or colectomy (285), and those having open gastric (97) or colorectal (934) resections were combined in a meta-analysis. Patients who had resection for cancer of the oesophagus (41) or pancreas (246) were analysed separately owing to heterogeneity. CRP levels 4days after surgery had the highest diagnostic accuracy (AUC 076, 95 per cent c.i. 073 to 078). Sensitivity and specificity were 685 (606 to 755) and 716 (666 to 760) per cent respectively. Positive and negative predictive values were 504 (460 to 548) and 843 (808 to 873) per cent. The threshold CRP varied according to the procedure performed. ConclusionThe negative predictive value of serum CRP concentration on day 4 after surgery facilitates reliable exclusion of postoperative infectious complications. Low C-reactive protein on day 4 predictive