What is Abnormal? The Utility of C-Reactive Protein as a Marker of Sepsis Post Major Urological Surgery
BAUS ePoster online library. Khoo C.
Jun 26, 2018; 211354
Mr. Charlie Khoo
Mr. Charlie Khoo
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Introduction: Post-operative infection increases morbidity and mortality. NICE recommends CRP measurement to guide sepsis management; however, post-operatively, an infectious CRP rise may be misattributed as surgical. We evaluated the utility of CRP in diagnosing infection after major urological surgery.

Patients and Methods: All patients undergoing major urological surgery at our institution over 10 months were included. Operation, route, Charlson index, infective complications and CRP measurements for post-operative days 1-10 were recorded. Receiver operating characteristics were plotted, and procedure and patient specific risks for CRP elevation were explored.

Results: 117 patients were included. Procedural differences in post-operative CRP were statistically significant on days 1 to 3 (Kruskal-Wallace test; p<0.05). Prostatectomy caused least perturbation of CRP, and retroperitoneal lymph node dissection the most. CRP performs well as a marker of infection from post-operative days 2 to 8. Discriminatory power is best for patients with septic shock, peaking at post-operative day 5 (p<0.0001). In binary logistic regression, adjusting for operation, route, and Charlson Index, CRP remained a statistically significant independent marker of simple infections from days 2 to 6, sepsis from days 2 to 6, and septic shock from days 3 to 6 (table 1). Laparoscopic route caused both lower CRP levels and lower rate of septic shock compared to open (Fisher's exact test; p=0.012).

Conclusions: CRP has high discriminatory power as a marker of infection from post-operative days 2 to 6. Procedure and route have a large influence on CRP from day 1, and should be considered when evaluating what is abnormal.
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