The Use of C-Reactive Protein (CRP) as a Marker of the Surgical Stress in Gastrointestinal Surgery

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The Use of C-Reactive Protein (CRP) as a Marker of the Surgical Stress in Gastrointestinal Surgery

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 10, Issue 1

Abstract

Being able to predict the complications that can arise after a surgical intervention is essential to accelerate the recovery of patients, minimize pain or save their lives in the most crucial cases. Different markers of surgical aggression [1-3] have been studied, being to use C-reactive protein (CRP) measurement during the postoperative period the current trend to predict the evolution of the patients [4-6]. A brief review of the utility of CRP measurement is showed to assess its use as the choice marker of the surgical injury.After surgery, it is necessary to establish a series of markers that tell us the patient prognosis and allow a prompt action whether it is not favourable. CRP is a tissue aggression marker. Multiple studies incorporate it to see the immune response of the patients after the surgical aggression and then study the degree of inflammatory response (7-10). The higher its value, the higher the probability of systemic inflammatory response syndrome (SIRS). CRP measurement is done just before surgery and in the postoperative days to see its evolution. Whether its values increase with time, it is indicative of a greater inflammatory response, and therefore, of a possible complication during recovery.Within the gastrointestinal surgery there are two fundamental surgical procedures, open surgery (OS) and laparoscopic surgery (LS). Although evidence-based medicine shows that the laparoscopic approach is more beneficial for the patient and its recovery [1113], there are still some doubts about its use since discrepancies have been obtained in studies to observe the immune response of patients [14-16], especially in certain surgical resections or when their performance cannot be carried out by properly trained surgeons. CRP is the usual marker used among others to compare both surgical approaches and justify that approach produces a lower inflammatory response, and therefore would be the most beneficial for the patient recovery. Most studies indicate lower values of CRP in LS compared to OS in the postoperative days [1720]. Few studies find no significant differences between OS and LS groups [21,22], characterized by having a low number of study subjects or because the clinical and surgical characteristics (body mass index, duration of surgery, blood loss) have differed between the two comparison groups. These facts would indicate that CRP is a good marker of the inflammatory response, since its value increases taking into account all the factors of study and is not only affected by the surgical approach. In fact, several studies have observed there are no significant differences in CRP values when comparing OS and LS in patients who have suffered complications [4], even comparing patients included in ERAS protocols versus standard care protocols [6].

Authors and Affiliations

Ana Belen Martinez Martinez

Keywords

CRP Laparoscopic Surgery Gastrointestinal Surgery Postoperative Period Inflammation Marker Implementation Surgical Injury Cortisol Concentrations Magnitude Cytokines

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EP ID EP591851
DOI 10.26717/BJSTR.2018.10.001894
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