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Relationship between C-reactive protein levels and wound infections in elective colorectal surgery: C-reactive protein as a predictor for incisional SSI.

BACKGROUND/AIMS
Serum C-reactive protein (CRP) is an acknowledged marker of infections. For early detection of postoperative infections, CRP levels may be a useful marker. In this study, the CRP response with respect to wound infections (incisional surgical site infection (SSI)) in elective colorectal surgery was examined to define the role of serum CRP as a predictor of incisional SSI.


METHODOLOGY
One hundred forty-eight patients who underwent elective colorectal resection were identified for inclusion in this study. The outcome of interest was incisional SSI. Twenty-eight patients with incisional SSI were compared to a subgroup of 118 patients with an uneventful postoperative course, and the correlation between postoperative serum CRP levels and incisional SSI in colorectal surgery was investigated.


RESULTS
For uneventful cases, the CRP rose postoperatively to a maximum on the third day, and the concentrations then returned to near normal levels on postoperative day (POD) 7. In incisional SSI cases, persistent elevation or a second rise in CRP concentrations was seen. Although no statistically significant differences in CRP concentrations were seen on POD 1 or 3, the initial rise in CRP of cases with incisional SSI was relatively higher compared to uneventful cases. A deviation became obvious at POD 7. A cut-off level of 36 mg/L on POD 7 was recorded (sensitivity of 71.4% and a specificity of 83.1%) for incisional SSI.


CONCLUSION
Our results suggest that elevated serum CRP levels are correlated with incisional SSI. Persistent CRP elevation is predictive of incisional SSI in colorectal surgery if pneumonia or anastomotic leakage are unlikely or excluded.