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C-Reactive Protein Kinetics After Major Surgery

Santonocito, Cristina MD*; De Loecker, Isabelle MD*; Donadello, Katia MD*; Moussa, Mouhamed D. MD*; Markowicz, Samuel MD*; Gullo, Antonino MD; Vincent, Jean-Louis MD, PhD*

doi: 10.1213/ANE.0000000000000263
Critical Care, Trauma, and Resuscitation: Research Report

BACKGROUND: Diagnosis of sepsis in the postoperative period is a challenge. Measurements of inflammatory markers, such as C-reactive protein (CRP), have been proposed in medical patients, but the interpretation of these values in surgical patients is more difficult. We evaluated the changes in blood CRP levels and white blood cell count in postoperative patients with and without infection.

METHODS: All patients admitted to our 34-bed Department of Intensive Care after major (elective or emergency) cardiac, neuro-, vascular, thoracic, or abdominal surgery during a 4-month period were prospectively included. Patients were screened daily and characterized as infected or noninfected. CRP levels and white blood cell counts were recorded daily in all patients for up to 7 days after the surgical intervention.

RESULTS: Of the 151 patients enrolled, 115 underwent elective surgery and 36 emergency surgery; cardiac surgery was performed in 49 patients, neurosurgery in 65, abdominal surgery in 25, vascular surgery in 7, and thoracic surgery in 5. In noninfected patients (n = 117), mean CRP values increased from baseline to postoperative day (POD) 3 (P < 0.0001, estimated mean difference [EMD] = 99.7 mg/L [95% confidence interval, 85.6–113.8]) and then decreased until POD 7 but remained higher than the level at baseline (P < 0.0001, EMD = 49.2 mg/L [95% confidence interval, 27.1–71.2]). Postoperative infection occurred in 20 patients (13.2%). In these patients, CRP values were already higher on POD 1 than in noninfected patients (P = 0.0054).

CONCLUSIONS: CRP levels increase in the first week after major surgery but to a much larger extent in infected than in noninfected patients. Persistently high CRP levels after POD 4, especially when >100 mg/L, suggest the presence of a postoperative infection.

Published ahead of print May 30, 2014.

From the *Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; and †Department of Intensive Care, AOU Policlinicao–Vittorio Emanuele, Univerità degli Studi di Catania, Catania, Italy.

Published ahead of print May 30, 2014.

Accepted for publication March 13, 2014.

Funding: No external funding.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Jean-Louis Vincent, MD, PhD, Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels. Address e-mail to

© 2014 International Anesthesia Research Society