Can C-reactive protein predict the severity of a post-operative complication after elective resection of colorectal cancer?

AIMS: To explore if post-operative day 3 C-reactive protein (CRP), the ratio of pre-operative to day 3 white cell count (WCC) and platelet count can be used to predict the risk of post-operative complication and stratify the severity of complications as defined by the Clavien-Dindo classification.

METHODS: Data was obtained retrospectively on 127 patients who had elective bowel resection for malignancy between 2011 and 2013. Baseline demographics and clinical details were obtained including pre-operative and day 3 WCC and platelets and day 3 CRP. Ratio of pre-operative to day 3 WCC and platelets was calculated. Outcome measures were if a complication occurred (death included) and complication as defined by the Clavien-Dindo clasification. Mann-Whitney U test and Kruskal-Wallis were used to test for significance.

RESULTS: Of 127 patients, 57 % (n = 73) were male with a total median age of 72 and the commonest histology result T3N0 (40.6 %, n = 52). CRP was found to predict a complication (p < 0.0005) and the severity of complication as per the Clavien-Dindo classification (p < 0.0005). Day 3 CRP over 285 suggested a life-threatening complication (Clavien-Dindo score 4). There was no statistical significance between the ratio of WCC and platelets to any of the outcome measures.

CONCLUSIONS: WCC, platelets and CRP are routinely performed in the post-operative period. Previous research has shown CRP to be a good predictor of a complication. This paper has shown that day 3 CRP can not only predict but can also stratify the severity of post-operative complications.