P399 C-Reactive Protein Values After Surgery for Inflammatory Bowel Disease: Is It Still A Good Marker For Intra-Abdominal Complication? A Retrospective Cohort Study of 347 procedures.
Gaspard, B.(1);Alexandre, C.(1);thibault, V.(1);Lauren, O.(2);Clotilde, D.(1);Najim, C.(1);yann, P.(1);Lefevre, J.(1);
(1)APHP St. Antoine Hospital, Department of General and Digestive Surgery, Paris, France;(2)St Vincent's University Hospital, Department of Colorectal Surgery, Dublin, Ireland; Saint-Antoine IBD Network
Background
C-reactive protein (CRP) is a useful predictive test to early detect abdominal complication after colorectal surgery. Inflammatory bowel disease (IBD) is responsible of chronic inflammation and abnormal basal CRP that could influence the interest of its management after abdominal surgery.
The aim of this study was to evaluate CRP as an indicator of postoperative complication in a specific IBD population.
Methods
Retrospective study of patients undergoing ileocolic resection or ileal pouch-anal anastomosis for IBD between 2012 and 2019.
Intra-abdominal complication was defined as any intra-abdominal event, infectious or otherwise, occurring during the immediate postoperative period.
The early postoperative period was defined as post-operative days (POD) 1 and 2 and late postoperative period as POD 3 and 4.
Results
Ileocolic resection represented 242 patients and ileal pouch-anal anastomosis 105 patients.
Intra-abdominal complications occured in 18.1% of patients (ICR=40, 16.5% and IPAA=23, 21.9%).
Pre-operative CRP (48 hours before surgery) was available for 96 patients (29.8%). Among them, 64 had an abnormal CRP value (median: 13±45.4). No relation was found between a preoperative abnormal CRP value and post-operative intra-abdominal complications.
CRP was significantly higher at an early (105.2±56.0 vs 128.1±69.8; p=0.008) and late stage (112.9±72.8 vs 185.3±111.5; p < 0.0001) for patients having an intra-abdominal complication.The best sensitivity and specificity values were obtained at POD 3-4 with a CRP cut-off of 75 with an area under the curve of 0.71. The ability to rule out an intra-abdominal complication with a CRP Value <75 mg/L was good with, at POD 1-2 NPV=86.4% and PPV=19.9% and, at POD 3 an NPV=90.3% and PPV=22.2%.
A BMI >25kg/m2 (p=0.04) and an open surgical approach (p=0.009) were associated with higher CRP levels in the first POD.
In multivariate analysis, pre-operative steroid use (p=0.03), CRP at POD 3 > 100mg/L (p=0.002) and a rise between CRP values more than 50 mg/L (p=0.005) or 100 mg/L (p < 0.0001) at 48 hours were significantly associated with intra-abdominal complication. A CRP at POD 1 <75mg/L was associated with a lower rate of intra-abdominal complication (p=0.01).
A score using these 4 independent factors was created and showed significant differences in intra-abdominal complication, anastomotic leakage and readmission rate.
Conclusion
CRP is a useful predictive marker to detect abdominal complication after surgery in IBD population. Measurement of CRP can help to reduce hospitalization stay and orientate towards complementary examinations.