Rising C-reactive protein and procalcitonin levels precede early complications after esophagectomy

Sandra H Hoeboer, A B Johan Groeneveld, Noel Engels, Michel van Genderen, Bas P L Wijnhoven, Jasper van Bommel, Sandra H Hoeboer, A B Johan Groeneveld, Noel Engels, Michel van Genderen, Bas P L Wijnhoven, Jasper van Bommel

Abstract

Background: Elective esophagectomy with gastric tube reconstruction carries a high risk for complications. Early and accurate diagnosis could improve patient management. Increased C-reactive protein (CRP) levels may be associated with any, surgical or infectious, complication and procalcitonin (PCT) specifically with infectious complications.

Methods: We measured CRP and PCT on post-operative days 0, 1, 2, and 3 in 45 consecutive patients. Complications were recorded up to 10 days post-esophagectomy.

Results: Twenty-eight patients developed a post-operative complication (5 surgical, 14 infectious, 9 combined surgical/infectious, including anastomotic leakage), presenting on day 3 or later. Elevated days 2 and 3 and a rise in CRP preceded the diagnosis of general or combined surgical/infectious complications (minimum area under the receiver operating characteristics curve (AUROC) 0.75, P = 0.006). Elevated day 3 PCT preceded combined complications (AUROC 0.86, P < 0.001). High day 1 and 3 PCT levels preceded anastomotic leakage (minimum AUROC 0.76, P = 0.005), as did the day 3 CRP levels and their increases (minimum AUROC 0.78, P = 0.002).

Conclusions: This small study suggests that high or increasing CRP levels may precede the clinical diagnosis of general or surgical/infectious complications after esophagectomy. Elevated PCT levels may more specifically and timely precede combined surgical/infectious complications mainly associated with anastomotic leakage.

Conflict of interest statement

None of the authors reported any conflict of interest.

Figures

Fig. 1
Fig. 1
Early leukocyte and plasma biomarker levels (median and inter-quartile range) for complications up to 10 days after elective esophagectomy. Without complications (N = 17) (circle), with complications (N = 28) (square). CRP C-reactive protein, PCT procalcitonin. P values refer to Mann-Whitney U test
Fig. 2
Fig. 2
Early leukocyte and plasma biomarker levels (median and inter-quartile range) for complications up to 10 days after elective esophagectomy. Without complications (N = 17) (circle), surgical complications (N = 5) (square), infectious complications (N = 14) (triangle), combined surgical/infectious complications (N = 9) (inverted triangle). CRP C-reactive protein, PCT procalcitonin. P values refer to Kruskal-Wallis test
Fig. 3
Fig. 3
Early leukocyte and plasma biomarker levels (median and inter-quartile range) for complications up to 10 days after elective esophagectomy. Without complications (N = 17) (circle), with other complications (N = 18) (square), with anastomotic leakage (N = 10) (triangle), CRP C-reactive protein, PCT procalcitonin. P values refer to Kruskal-Wallis test

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