The Predictive Ability of C-reactive Protein for Complications After Laparoscopy-assisted Gastrectomy

Kecheng Zhang, Hongqing Xi, Jianxin Cui, Bo Wei, Ning Wang, Shibo Bian, Liangang Ma, Lin Chen. Department of General Surgery, Chinese People’s Liberation Army of General Hospital

Purpose: To investigate the diagnostic accuracy of C-reactive protein (CRP) and white blood cell (WBC) for early detection of complications following laparoscopy-assisted gastrectomy (LAG) and to construct a nomogram for clinical dicision-making.

Methods: Clinical data of consecutive patients underwent LAG with curative intent between December 2013 and March 2015 was prospectively collected. Postoperative complications were recorded according to the Clavien-Dindo classification. The diagnostic value of CRP and WBC was evaluated by area under the curve (AUC) of receiver operating characteristic curve (ROC). Optimal cut-off value was determined by Youden’s index. Univariate and multivariate logistic regression analysis were conducted to identify risk factors for complications and then a nomogram was constructed.

Results: A total of 278 patients successfully underwent laparoscopy-assisted gastrectomy. Twenty-nine patients (10.4%) developed major complications (grade ≥ III). CRP on postoperative day 3 (POD3) and WBC on POD7 had highest diagnostic accuracy for major complications with an AUC value of 0.86 [95% confidence interval (CI), 0.79-0.92] and 0.68 (95% CI, 0.56-0.79) respectively. An optimal cut-off value of 17.2 mg/l was identified for CRP, yielding a sensitivity of 0.79 (95% CI, 0.60-0.92) and specificity 0.74 (95% CI, 0.68-0.80). Multivariate analysis identified POD3 CRP values ≥ 17.2 mg/l, Eastern Cooperative Oncology Group Performance Status ≥ 1, presence of preoperative comorbidity and operation time ≥ 240 min were risk factors for major complications after LAG.

Conclusion: CRP on POD3 and CRP-based nomogram contribute to early detection of complications after LAG.

Figure 1. (a) The chronological changes of CRP concentration (median with interquartile range) for major complications (MC) and no complications (NC). ^*P < 0.05 (b) Receiver operating characteristic curve (ROC) for postoperative day 3 (POD3) CRP with an AUC value of 0.86.