Cousin et al evaluated patients after elective colorectal cancer using serum C-reactive protein (CRP) or procalcitonin. The serum concentrations between 3 and 5 days after surgery can help to identify a patient at low risk for intra-abdominal infection. The authors are from Dijon University in France and Sapienza University of Rome.
Patient selection: elective colorectal cancer
Analysis: serial serum CRP or procalcitonin on postoperative days (POD) 2, 3, 4 or 5
A patient with a postoperative infection tends to become symptomatic 7 to 9 days after surgery. However, the serum concentrations of CRP and procalcitonin start to rise several days before the clinical onset.
A serum CRP < 130 mg/L on POD 3 can be safely discharged.
The corresponding serum procalcitonin level is 0.27 ng/mL.
Alternative strategies can use different cut-offs on days 4 or 5.
While either CRP or procalcitonin can be used, CRP is significantly cheaper to perform.
Limitations: This should work for most patients having elective surgery. However, some patients may have other reasons for an elevated CRP so may not meet the rule yet not have intra-abdominal infection.
