Skip to main content

Advertisement

SpringerLink
Log in

Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review

  • Review Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in PubMed from inception to July 2013 that met the following inclusion criteria: evaluation of the above parameters, describing their diagnostic accuracy and the risk stratification for surgical complications in surgical patients admitted to an intensive care unit. No difference in the Sequential Organ Failure Assessment scores was seen between patients with or without complications. The d-lactate levels were significantly higher in those who developed colonic ischemic complications after a ruptured abdominal aortic aneurysm. After gastro-intestinal surgery, contradictory data were reported, with both positive and negative use of C-reactive protein and procalcitonin in the diagnosis of septic complications. However, in trauma patients, the C-reactive protein levels may help to discriminate between those with and without infectious causes. We conclude that the Sequential Organ Failure Assessment score, lactate concentration and C-reactive protein level have no significant predictive value for early postoperative complications in critically ill post-surgery patients. However, procalcitonin seems to be a useful parameter for diagnosing complications in specific patient populations after surgery and/or after trauma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Melot C, et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest. 2003;123:2043–9.

    Article  CAS  PubMed  Google Scholar 

  2. Korner H, Nielsen HJ, Soreide JA, Nedrebo BS, Soreide K, Knapp JC. Diagnostic accuracy of C-reactive protein for intraabdominal infections after colorectal resections. J Gastrointest Surg. 2009;13:1599–606.

    Article  PubMed  Google Scholar 

  3. MacKay GJ, Molloy RG, O’Dwyer PJ. C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection. Colorectal Dis. 2011;13:583–7.

    Article  CAS  PubMed  Google Scholar 

  4. Matthiessen P, Henriksson M, Hallbook O, Grunditz E, Noren B, Arbman G. Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection. Colorectal Dis. 2008;10:75–80.

    Article  CAS  PubMed  Google Scholar 

  5. Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19:4168–77.

    Article  PubMed  Google Scholar 

  6. Warschkow R, Tarantino I, Torzewski M, Naf F, Lange J, Steffen T. Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of inflammatory complications after open resection of colorectal cancer: a retrospective study of 1187 patients. Int J Colorectal Dis. 2011;26:1405–13.

    Article  PubMed  Google Scholar 

  7. Woeste G, Muller C, Bechstein WO, Wullstein C. Increased serum levels of C-reactive protein precede anastomotic leakage in colorectal surgery. World J Surg. 2010;34:140–6.

    Article  PubMed  Google Scholar 

  8. Takakura Y, Hinoi T, Egi H, Shimomura M, Adachi T, Saito Y, et al. Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery. Langenbecks Arch Surg. 2013;398:833–9.

    Article  PubMed  Google Scholar 

  9. Nason GJ, Barry BD, Obinwa O, McMacken E, Rajaretnam NS, Neary PC. Early rise in C-reactive protein is a marker for infective complications in laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech. 2014;24:57–61.

    Article  PubMed  Google Scholar 

  10. Scepanovic MS, Kovacevic B, Cijan V, Antic A, Petrovic Z, Asceric R, et al. C-reactive protein as an early predictor for anastomotic leakage in elective abdominal surgery. Tech Coloproctol. 2013;17:541–7.

    Article  CAS  PubMed  Google Scholar 

  11. Welsch T, Muller SA, Ulrich A, Kischlat A, Hinz U, Kienle P, et al. C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis. 2007;22:1499–507.

    Article  CAS  PubMed  Google Scholar 

  12. Ortega-Deballon P, Radais F, Facy O, d’Athis P, Masson D, Charles PE, et al. C-reactive protein is an early predictor of septic complications after elective colorectal surgery. World J Surg. 2010;34:808–14.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Pedersen T, Roikjaer O, Jess P. Increased levels of C-reactive protein and leukocyte count are poor predictors of anastomotic leakage following laparoscopic colorectal resection. Dan Med J. 2012;59:A4552.

    PubMed  Google Scholar 

  14. Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006;34:1996–2003.

    Article  CAS  PubMed  Google Scholar 

  15. Reith HB, Mittelkotter U, Debus ES, Kussner C, Thiede A. Procalcitonin in early detection of postoperative complications. Dig Surg. 1998;15:260–5.

    Article  CAS  PubMed  Google Scholar 

  16. Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schuttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med. 1998;24:680–4.

    Article  CAS  PubMed  Google Scholar 

  17. Reith HB, Mittelkotter U, Wagner R, Thiede A. Procalcitonin (PCT) in patients with abdominal sepsis. Intensive Care Med. 2000;26(Suppl 2):S165–9.

    Article  PubMed  Google Scholar 

  18. Di Filippo A, Lombardi A, Ognibene A, Messeri G, Tonelli F. Procalcitonin as an early marker of postoperative infectious complications. Minerva Chir. 2002;57:59–62.

    PubMed  Google Scholar 

  19. Oberhofer D, Juras J, Pavicic AM, Rancic Zuric I, Rumenjak V. Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery. Croat Med J. 2012;53:612–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Lagoutte N, Facy O, Ravoire A, Chalumeau C, Jonval L, Rat P, et al. C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery: pilot study in 100 patients. J Visc Surg. 2012;149:e345–9.

    Article  CAS  PubMed  Google Scholar 

  21. Garcia-Granero A, Frasson M, Flor-Lorente B, Blanco F, Puga R, Carratala A, et al. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum. 2013;56:475–83.

    Article  PubMed  Google Scholar 

  22. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.

    Article  CAS  PubMed  Google Scholar 

  23. Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care. 1999;3:45–50.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care. 2004;8:R60–5.

    Article  PubMed Central  PubMed  Google Scholar 

  25. McNelis J, Marini CP, Jurkiewicz A, Szomstein S, Simms HH, Ritter G, et al. Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit. Am J Surg. 2001;182:481–5.

    Article  CAS  PubMed  Google Scholar 

  26. Husain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg. 2003;185:485–91.

    Article  PubMed  Google Scholar 

  27. Hajjar LA, Almeida JP, Fukushima JT, Rhodes A, Vincent JL, Osawa EA, et al. High lactate levels are predictors of major complications after cardiac surgery. J Thorac Cardiovasc Surg. 2013;146:455–60.

    Article  CAS  PubMed  Google Scholar 

  28. Sheng-Hua L, Kai-Qin P, Fen L, Yang Y, Tao X, Ying-Tian Z. Changes in blood lactate levels after major elective abdominal surgery and the association with outcomes: a prospective observational study. J Surg Res. 2013;184:1059–69.

    Article  Google Scholar 

  29. Meyer ZC, Schreinemakers JM, Mulder PG, de Waal RA, Ermens AA, van der Laan L. The role of C-reactive protein and the SOFA score as parameter for clinical decision making in surgical patients during the intensive care unit course. PLoS One. 2013;8:e55964.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Watanabe I, Mayumi T, Arishima T, Takahashi H, Shikano T, Nakao A, et al. Hyperlactemia can predict the prognosis of liver resection. Shock. 2007;28:35–8.

    Article  CAS  PubMed  Google Scholar 

  31. Poeze M, Froon AH, Greve JW, Ramsay G. d-lactate as an early marker of intestinal ischaemia after ruptured abdominal aortic aneurysm repair. Br J Surg. 1998;85:1221–4.

    Article  CAS  PubMed  Google Scholar 

  32. Meyer ZC, Schreinemakers JM, Mulder PG, de Waal RA, Ermens AA, van der Laan L. Determining the clinical value of lactate in surgical patients on the intensive care unit. J Surg Res. 2013;183:814–20.

    Article  CAS  PubMed  Google Scholar 

  33. van Genderen ME, Lima A, de Geus H, Klijn E, Wijnhoven B, Gommers D, et al. Serum C-reactive protein as a predictor of morbidity and mortality in intensive care unit patients after esophagectomy. Ann Thorac Surg. 2011;91:1775–9.

    Article  PubMed  Google Scholar 

  34. Bogar L, Molnar Z, Tarsoly P, Kenyeres P, Marton S. Serum procalcitonin level and leukocyte antisedimentation rate as early predictors of respiratory dysfunction after oesophageal tumour resection. Crit Care. 2006;10:R110.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Chromik AM, Meiser A, Holling J, Sulberg D, Daigeler A, Meurer K, et al. Identification of patients at risk for development of tertiary peritonitis on a surgical intensive care unit. J Gastrointest Surg : Off J Soc Surge Aliment Tract. 2009;13:1358–67.

    Article  Google Scholar 

  36. Miller PR, Munn DD, Meredith JW, Chang MC. Systemic inflammatory response syndrome in the trauma intensive care unit: who is infected? J Trauma. 1999;47:1004–8.

    Article  CAS  PubMed  Google Scholar 

  37. Castelli GP, Pognani C, Cita M, Stuani A, Sgarbi L, Paladini R. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis. Minerva Anestesiol. 2006;72:69–80.

    CAS  PubMed  Google Scholar 

  38. Castelli GP, Pognani C, Cita M, Paladini R. Procalcitonin as a prognostic and diagnostic tool for septic complications after major trauma. Crit Care Med. 2009;37:1845–9.

    Article  PubMed  Google Scholar 

  39. Steinbach G, Bolke E, Schulte am Esch J, Peiper M, Zant R, Schwarz A, et al. Comparison of whole blood interleukin-8 and plasma interleukin-8 as a predictor for sepsis in postoperative patients. Clin Chim Acta. 2007;378:117–21.

    Article  CAS  PubMed  Google Scholar 

  40. Novotny A, Emmanuel K, Matevossian E, Kriner M, Ulm K, Bartels H, et al. Use of procalcitonin for early prediction of lethal outcome of postoperative sepsis. Am J Surg. 2007;194:35–9.

    Article  CAS  PubMed  Google Scholar 

  41. Schneider CP, Yilmaz Y, Kleespies A, Jauch KW, Hartl WH. Accuracy of procalcitonin for outcome prediction in unselected postoperative critically ill patients. Shock. 2009;31:568–73.

    Article  CAS  PubMed  Google Scholar 

  42. Dahaba AA, Hagara B, Fall A, Rehak PH, List WF, Metzler H. Procalcitonin for early prediction of survival outcome in postoperative critically ill patients with severe sepsis. Br J Anaesth. 2006;97:503–8.

    Article  CAS  PubMed  Google Scholar 

  43. Nie H, Jiang D, Ou Y, Quan Z, Hao J, Bai C, et al. Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury. Spinal Cord. 2011;49:715–20.

    Article  CAS  PubMed  Google Scholar 

  44. Svoboda P, Kantorova I, Scheer P, Radvanova J, Radvan M. Can procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery? Hepatogastroenterology. 2007;54:359–63.

    CAS  PubMed  Google Scholar 

  45. Al-Bahrani AZ, Darwish A, Hamza N, Benson J, Eddleston JM, Snider RH, et al. Gut barrier dysfunction in critically ill surgical patients with abdominal compartment syndrome. Pancreas. 2010;39:1064–9.

    Article  PubMed  Google Scholar 

  46. Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth. 2005;94:767–73.

    Article  CAS  PubMed  Google Scholar 

  47. Sautner T, Gotzinger P, Redl-Wenzl EM, Dittrich K, Felfernig M, Sporn P, et al. Does reoperation for abdominal sepsis enhance the inflammatory host response? Arch Surg. 1997;132:250–5.

    Article  CAS  PubMed  Google Scholar 

  48. Zugel N, Siebeck M, Geissler B, Lichtwark-Aschoff M, Gippner-Steppert C, Witte J, et al. Circulating mediators and organ function in patients undergoing planned relaparotomy vs conventional surgical therapy in severe secondary peritonitis. Arch Surg. 2002;137:590–9.

    Article  PubMed  Google Scholar 

  49. Meisner M, Adina H, Schmidt J. Correlation of procalcitonin and C-reactive protein to inflammation, complications, and outcome during the intensive care unit course of multiple-trauma patients. Crit Care. 2006;10:R1.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007;7:210–7.

    Article  CAS  PubMed  Google Scholar 

  51. Clec’h C, Fosse JP, Karoubi P, Vincent F, Chouahi I, Hamza L, et al. Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock. Crit Care Med. 2006;34:102–7.

    Article  PubMed  Google Scholar 

  52. Meisner M. Pathobiochemistry and clinical use of procalcitonin. Clin Chim Acta. 2002;323:17–29.

    Article  CAS  PubMed  Google Scholar 

  53. Rau B, Kruger CM, Schilling MK. Procalcitonin: improved biochemical severity stratification and postoperative monitoring in severe abdominal inflammation and sepsis. Langenbecks Arch Surg. 2004;389:134–44.

    Article  CAS  PubMed  Google Scholar 

  54. Delevaux I, Andre M, Colombier M, Albuisson E, Meylheuc F, Begue RJ, et al. Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes? Ann Rheum Dis. 2003;62:337–40.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

Z. C. Meyer and co-authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Amphia Hospital, Molengracht 21, 4818, Breda, CK, The Netherlands

    Zainna C. Meyer, Jennifer M. J. Schreinemakers & Lijckle van der Laan

  2. Department of Intensive Care Medicine, Amphia Hospital, Breda, The Netherlands

    Ruud A. L. de Waal

Authors
  1. Zainna C. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer M. J. Schreinemakers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ruud A. L. de Waal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lijckle van der Laan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zainna C. Meyer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meyer, Z.C., Schreinemakers, J.M.J., de Waal, R.A.L. et al. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review. Surg Today 45, 1091–1101 (2015). https://doi.org/10.1007/s00595-015-1159-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-015-1159-6

Keywords

Search

Navigation