P765 Role of C-reactive protein kinetics after surgery for Crohn's disease. (16th January 2018)

• Record Type: Journal Article
• Authors: Carvello, M; Di Candido, F; Fiorino, G; Danese, S; Spinelli, A
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S498
• Page End: S498
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.892
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: C-reactive protein (CRP) is a reliable predictor of major anastomotic leak after colorectal resection for cancer. However, there is lack of data on its role when surgical resection is performed for Crohn's disease (CD). Moreover, the higher postoperative CRP level of CD patients, as a consequence of an enhanced postoperative inflammatory response, may not reflect an actual underlying septic complication. The aim of this study is to characterise postoperative CRP kinetics with regards to postoperative course and its relevance in predicting anastomotic leakage after CD surgery. Methods: All CD patients undergoing surgical resection with primary anastomosis between January 2013 and January 2017 were retrospectively analysed. Demographic, surgical, comorbidity was collected. Postoperative CRP levels, measured daily until discharge, were retrieved. Data regarding postoperative course including anastomotic leakage, infectious and non-infectious complications were retrieved. The discrimination ability of CRP levels in predicting the incidence of anastomotic leakage was evaluated according to the area under the curve (AUC), using the receiver-operating characteristic (ROC) methodology. Results: A series of 251 consecutive patients who underwent elective colorectal surgery in a specialised unit was retrospectively analysed. Anastomotic leak was detected in 10 patients (4%). C-reactive protein level was a good predictor of anastomotic leak on postoperative day 3 to 5 (AUC equal to 0.741, 0.783 and 0.825 for day 3, 4 and 5, respectively). A delta cut-off of 14 measured between the first and the third day after surgery (AUC .800) maximises sensitivity and specificity (NVP: 98.6% PPV 27%). Conclusions: Postoperative C-reactive protein could be a useful tool to rule out anastomotic complications after surgery for CD. Its high negative predictive value is crucial to allow early discharge and reduce hospital-acquired infection in particularly fragile CD patients after surgery