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Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of inflammatory complications after open resection of colorectal cancer: a retrospective study of 1,187 patients

Warschkow, Rene ; Tarantino, Ignazio ; Torzewski, Michael ; Näf, Franziska ; Lange, Jochen ; Steffen, Thomas

In: International Journal of Colorectal Disease, 2011, vol. 26, no. 11, p. 1405-1413

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    Titre
    • Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of inflammatory complications after open resection of colorectal cancer: a retrospective study of 1,187 patients
    Auteur
    • Warschkow, Rene. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Tarantino, Ignazio. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Torzewski, Michael. Institute of Clinical Microbiology and Immunology, 9007, St. Gallen, Switzerland
    • Näf, Franziska. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Lange, Jochen. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Steffen, Thomas. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • International Journal of Colorectal Disease, 2011, vol. 26, no. 11, p. 1405-1413. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:322082
    Summary
    Purpose: Although widely used, there is a lack of evidence concerning the diagnostic accuracy of C-reactive protein (CRP) and white blood cell counts (WBCs) in the postoperative period. The aim of this study was to evaluate the diagnostic accuracy of CRP and WBCs in predicting postoperative inflammatory complications after open resection of colorectal cancer. Methods: In this retrospective study, clinical data and the CRP and WBCs, routinely measured until postoperative day5 (POD 5), were available for 1,187 patients who underwent colorectal cancer surgery between 1997 and 2009. Using the receiver-operating characteristic (ROC) methodology, the diagnostic accuracy was evaluated according to the area under the curve (AUC). Results: Three hundred forty-seven patients (29.2%; 95% CI, 26.7-31.9%) developed various inflammatory complications. Anastomotic leakage occurred in 8.0% (95% CI, 6.1-9.1%) of patients. The CRP level on POD 4 (AUC 0.76; 95% CI, 0.71-0.81) had the highest diagnostic accuracy for the early detection of inflammatory complications. With a cutoff of 123mg/l, the sensitivity was 0.66 (95% CI, 0.56-0.74), and the specificity was 0.77 (95% CI, 0.71-0.82). The diagnostic accuracy of the WBC was significantly lower compared to CRP. Conclusion: Measurement of CRP on POD 4 is recommended to screen for inflammatory complications. CRP values above 123mg/l on POD 4 should raise suspicion of inflammatory complications, although the discriminatory performance was insufficient to provide a single threshold that could be used to correctly predict inflammatory complications in clinical practice. WBC measurement contributes little to the early detection of inflammatory complications. Registered at www.clinicaltrials.gov (NCT01221324)