Serum C-reactive protein as a prognostic variable in elective surgery ICU patients: especially valuable following esophagectomy

Introduction

Serum C-reactive protein (CRP) is synthesized in response to inflammatory status. Elevated CRP levels are associated with an increased risk of multiorgan failure in ICU patients. Preoperative elevation of serum CRP is a prognostic indicator in gastric and colorectal surgery. The aim of this study was to determine serum CRP as prognostic variable in patients undergoing esophagectomy with gastric tube reconstruction in contrast to other ICU admitted patients.

Methods

Data were collected retrospectively for a total of 208 patients admitted to the ICU following elective surgery from October 2007 to December 2008. Patients included underwent esophagectomy with gastric tube reconstruction, liver transplantation, hemihepatectomy, neuro- and abdominal aneurysm surgery. Postoperative serum markers were measured and the relation between the course of postoperative serum CRP, development of complications and prognosis of the patients was investigated.

Results

Postoperative serum CRP was significantly higher at T24 in patients undergoing esophagectomy with gastric tube reconstruction, compared with all other patients. Higher serum CRP levels correlated with the occurrence of complications in the heterogeneous ICU population but especially in the esophagectomy patients. Within this group, serum CRP levels at T24 and T48 were significantly higher in patients with a postoperative pneumonia, which in itself was associated with increased 1-year mortality.

Conclusions

Postoperative serum CRP levels can easily be monitored in the ICU in order to identify patients at risk for the development of postoperative complications. Especially in the esophagectomy patients, the occurrence of postoperative complications is associated with reduced survival.

Figure 1

CRP and complications in all groups.