C反应性蛋白在细胞外科手术和过度热腹膜化疗后感染性并发症的预测价值：一项单中心前瞻性研究
Predictive Value of C-Reactive Protein for Infectious Complications After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Single-Center Prospective Study
影响因子:3.50000
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
摘要
细胞减少手术（CRS）和高温腹膜内化学疗法（HIPEC）可能与明显的发病率和长时间住院相关。术后感染造成了这些并发症的高负担。这项研究旨在评估术后C反应性蛋白（CRP）水平的预测价值，以便在2018年至2020年间，Maisonneuve-Rosemont Hospital in Montreteal in Montreal ettreal，QC，QC，Cana Canca，Canca，CASCARE，MAISONNEUVE-ROSEMONT HOSPITION，MAISONNEUVE-ROSEMONT HOSPITION在2018年至2020年之间，对正在接受CRS的患者和HIPEC的患者进行了单一中心的前瞻性研究。手术后每天测量CRP水平10天。包括感染性并发症的患者与没有感染性并没有的患者进行了比较。包括九十九名患者。 30例患者患有感染性并发症（30.3％），四名患者发生吻合式泄漏（4％）。术后传染病并发症患者的CRP水平明显更高（POD）2-10。第8天最准确地预测的感染并发症的每日截止值（94.3 mg/l；曲线下的面积[AUC] 0.85，敏感性[SE SE] 76.2％，特异性[SP] 94.7％，正预测值[PPV] 88.9％，88.9％，负预测值[NPV] 87.8％； P <0.000; P <0.000; p <0.000）和7.8（77）。 SE 95.2％，SP 81.8％，PPV 76.9％，NPV 96.4％；感染并发症的患者手术时间更长，腹膜癌指数较高，并且肠道吻合术的数量更高，而其基线特征则是可比的。CRP的测量有助于预测CRS和HIPEC后的感染并发症，尤其是在PODS 8和9中，尤其是在第8和9号的POD上。截止值是在第一次邮政邮局之后的临界值更准确，尤其是在排除Intectious Intectious Intectious fircectious Inftectious Inftectious Inftectious Intcectious。
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.