C-反应蛋白在细胞减灭手术及热腹腔内化疗后感染并发症预测价值：单中心前瞻性研究

Predictive Value of C-Reactive Protein for Infectious Complications After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Single-Center Prospective Study

ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

分区:医学2区 / 外科2区肿瘤学3区

发表日期:2024 Dec

作者: Janyssa Charbonneau, Alexandre Brind'Amour, Lucas Sideris, Sabrina Piedimonte, Mikaël Soucisse, Narcisse Singbo, Jean-François Tremblay, Guy Leblanc, Suzanne Fortin, Lara De Guerké, Marie-Hélène Auclair, Mai-Kim Gervais

DOI: 10.1245/s10434-024-15986-3

摘要

细胞减灭手术（CRS）结合热腹腔内化疗（HIPEC）可能伴随显著的发病率和较长的住院时间。术后感染是这些并发症的重要组成部分。本研究旨在评估术后C-反应蛋白（CRP）水平对整体感染并发症和吻合口漏的预测价值。该研究为蒙特利尔QC加拿大Maisonneuve-Rosemont医院于2018至2020年进行的单中心前瞻性研究，纳入接受CRS和HIPEC治疗的腹膜转移患者。术后连续10天每日测定CRP水平。比较有感染并发症与无感染患者的CRP变化。共99例患者入组，其中30例发生感染（30.3%），4例出现吻合口漏（4%）。感染患者的CRP水平在术后第2至10天显著升高。每日最佳预测值在第8天（94.3 mg/L；曲线下面积[AUC] 0.85，敏感性[SE] 76.2%，特异性[SP] 94.7%，阳性预测值[PPV] 88.9%，阴性预测值[NPV] 87.8%；p < 0.0001）和第9天（72.7 mg/L；AUC 0.89，SE 95.2%，SP 81.8%，PPV 76.9%，NPV 96.4%；p < 0.0001）最为准确。感染患者手术时间更长，腹腔癌指数更高，肠道吻合数更多，但基础特征相似。CRP水平的测定有助于预测CRS和HIPEC术后的感染并发症，尤其是在第8和第9天。术后第一周后，临界值更具准确性，特别是在排除感染方面。

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can be associated with significant morbidity and prolonged hospital stay. Postoperative infections account for a high burden of these complications. This study aimed to assess the predictive value of postoperative C-reactive protein (CRP) levels for overall infectious complications and anastomotic leaks.This was a single-center prospective study of patients undergoing CRS and HIPEC for peritoneal metastases between 2018 and 2020 at Maisonneuve-Rosemont Hospital in Montreal, QC, Canada. CRP levels were measured daily for 10 days following surgery. A comparison was made between patients with infectious complications and those without.Ninety-nine patients were included. Thirty patients had infectious complications (30.3%) and four patients presented an anastomotic leak (4%). CRP levels were significantly higher in patients with infectious complications from postoperative days (PODs) 2-10. Daily cut-off values most accurately predicted infectious complications on day 8 (94.3 mg/L; area under the curve [AUC] 0.85, sensitivity [SE] 76.2%, specificity [SP] 94.7%, positive predictive value [PPV] 88.9%, negative predictive value [NPV] 87.8%; p < 0.0001) and day 9 (72.7 mg/L; AUC 0.89, SE 95.2%, SP 81.8%, PPV 76.9%, NPV 96.4%; p < 0.0001). Patients with infectious complications had longer operative time, higher peritoneal cancer index, and a higher number of intestinal anastomoses, while their baseline characteristics were comparable.Measurement of CRP helps predict infectious complications following CRS and HIPEC, particularly on PODs 8 and 9. Cut-off values are more accurate after the first postoperative week, especially in ruling out infectious complications.