Diagnostic Accuracy of Inflammatory Markers As Early Predictors of Infection After Elective Colorectal Surgery: Results From the IMACORS Study
Diagnostic Accuracy of Inflammatory Markers As Early Predictors of Infection After Elective Colorectal Surgery: Results From the IMACORS Study
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DOI：
10.1097/sla.0000000000001303
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发表时间：
2016-05-01
影响因子：
9
通讯作者：
Ortega-Deballon, Pablo
中科院分区：
文献类型：
--
作者：
Facy, Olivier;Paquette, Brice;Ortega-Deballon, Pablo
背景：腹内感染是结直肠手术后常见的危及生命的并发症。目的：本研究旨在寻找最准确的术后腹内感染标志物及其检测时机。方法：在3个中心进行前瞻性观察性研究。连续接受结直肠手术吻合术的患者包括在内。每天检测C反应蛋白和降钙素原，直到术后第4天。根据疾病控制中心的定义记录术后感染情况。分析比较受试者工作特征曲线下面积，评价各标志物的诊断准确性。结果：共分析501例患者。腹内感染发生率为11.8%，24.6%的患者出现至少一种感染并发症。总死亡率为1.2%。术后第4天，C反应蛋白较降钙素原更能区分腹内感染(ROC曲线下面积分别为0.775和0.689，P=0.03)。降钙素原水平呈弥散性分布。对于所有感染并发症的检测，C反应蛋白在术后第4天也明显高于降钙素原(ROC曲线下面积：0.783比0.671，P=0.0002)。结论：C反应蛋白对感染并发症的检测比降钙素原更准确，应在术后第4天系统测定。它是确保择期结直肠手术后安全早期出院的有用工具。
Background:Intra-abdominal infections are frequent and life-threatening complications after colorectal surgery. An early detection could diminish their clinical impact and permit safe early discharge.Objective:This study aimed to find the most accurate marker for the detection of postoperative intra-abdominal infection and the appropriate moment to measure it.Methods:A prospective, observational study was conducted in 3 centers. Consecutive patients undergoing elective colorectal surgery with anastomosis were included. C-reactive protein and procalcitonin were measured daily until the fourth postoperative day. Postoperative infections were recorded according to the definitions of the Centres for Diseases Control. The areas under the receiver operating characteristic curve were analyzed and compared to assess the diagnostic accuracy of each marker.Results: :Five-hundred and one patients were analyzed. The incidence of intra-abdominal infection was 11.8%, with 24.6% of patients presenting at least one infectious complication. Overall mortality was 1.2%. At the fourth postoperative day, C-reactive protein was more discriminating than procalcitonin for the detection of intra-abdominal infection (areas under the ROC curve: 0.775 vs 0.689, respectively, P = 0.03). Procalcitonin levels showed wide dispersion. For the detection of all infectious complications, C-reactive protein was also significantly more accurate than procalcitonin on the fourth postoperative day (areas under the ROC curve: 0.783 vs 0.671, P = 0.0002).Conclusions:C-reactive protein is more accurate than procalcitonin for the detection of infectious complications and should be systematically measured at the fourth postoperative day. It is a useful tool to ensure a safe early discharge after elective colorectal surgery.