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ABSTRACT
Introduction. Early detection of postoperative infections remains a challenge worldwide. The use of C-reactive protein (CRP) and procalcitonin (PCT) as predictive factors of the occurrence of these infections have not yet been studied in our context. Methods. This was a multicentre cross-sectional study conducted in Yaoundé. Prospectively, we collected all adult’s patients operated for an acute digestive abdomen through a laparotomy approach. CRP and PCT levels were measured preoperatively and in postoperative day 3. Patients were followed until postoperative day 14; the occurrence of a postoperative infectious complication (PIC) was the main outcome investigated. The Youden index, the receiver operating characteristic (ROC) and areas under the curve were used to determine the cut-off values of CRP and PCT with their sensibility and specificity. Results. We collected a total of 54 patients. PIC were the commonest morbidity, encountered in 38 cases (70.4%); they were diagnosed within an average of 5.65±1.8 days after the surgery. The postoperative (day 3) threshold value was of 68.8mg/ml (predictive positive value of 96.9%) and 5ng/ml (predictive positive value of 100%), respectively for CRP and PCT. The specificity of these cut-off values were of 90.7% and 100%, respectively for CRP and PCT. The sensibility of the cut off value was of 81.6% for CRP and 78;9% for PCT. The area under the ROC curve was of 0.956 (95% CI = [0.862- 0.993] for PCT and 0.894 (95% CI = [0.780-0.961]) for CRP. Conclusion. CRP and PCT values at postoperative day 3 can be used for the early diagnosis of PIC.
RÉSUMÉ
Introduction. La détection précoce des infections postopératoires reste un défi pour les praticiens. L'utilisation de la protéine C-réactive (CRP) et de la procalcitonine (PCT) comme facteurs prédictifs de la survenue de ces infections n'a pas encore été étudiée dans notre contexte. Methodes Il s'agissait d'une étude transversale multicentrique menée à Yaoundé. Prospectivement, nous avons colligé tous les patients adultes opérés par voie ouverte d'un abdomen aigu d’origine digestive. Les taux de CRP et de PCT ont été mesurés en préopératoire et au 3ème jour postopératoire. Les patients ont été suivis jusqu'au 14ème jour postopératoire ; la survenue d'une complication infectieuse postopératoire était le principal résultat étudié. L'indice de Youden, les courbes ROC et les aires sous la courbe ont été utilisés pour déterminer les valeurs seuil de CRP et PCT avec leur sensibilité et spécificité. Resultats. Nous avons recueilli un total de 54 patients. Les complications infectieuses étaient la morbidité la plus fréquente, rencontrées dans 38 cas (70,4 %) ; elles ont été diagnostiquées dans un délai moyen de 5,65 ± 1,8 jours après la chirurgie. La valeur seuil postopératoire (3ème jour) était de 68,8 mg/ml (valeur prédictive positive de 96,9 %) et de 5 ng/ml (valeur prédictive positive de 100 %), respectivement pour la CRP et la PCT. La spécificité de ces valeurs seuils était de 90,7 % et 100 %, respectivement pour la CRP et la PCT. La sensibilité de la valeur seuil était de 81,6 % pour la CRP et de 78,9 % pour la PCT. L'aire sous la courbe ROC était de 0,956 (IC à 95 % = [0,862- 0,993] pour la PCT et de 0,894 (IC à 95 % = [0,780-0,961]) pour la CRP. Conclusion. Les valeurs de CRP et PCT au jour 3ème jour postopératoire peuvent être utilisées pour le diagnostic précoce de complications infectieuses.
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References
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- - GlobalSurg Collaborative. Mortality of emergency abdominal surgery in high-, middle- and low-income countries. Br J Surg. 2016 Jul;103(8):971-988.
- - GlobalSurg Collaborative. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018;18(5):516-525.
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- - Naramura T, Imamura H, Yoshimatsu H, Hirashima K, Irie S, Inoue T et al. The Predictive Value of Procalcitonin and High-Sensitivity C-Reactive Protein for Early Bacterial Infections in Preterm Neonates. Neonatology 2021;118:28–36.
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- - Tatsuoka T, Okuyama T, Takeshita E, Oi H, Noro T, Mitsui T et al. Early detection of infectious complications using C-reactive protein and the procalcitonin levels after laparoscopic colorectal resection: a prospective cohort study. Surg Today 2021 ;51:397–403.
- - Facy O, Paquette B, Orry D, Binquet C, Masson D, Bouvier A et al. Diagnostic Accuracy of Inflammatory Markers As Early Predictors of Infection After Elective Colorectal Surgery: Results From the IMACORS Study. Ann Surg 2016;263:961–966.
- - Facy O, Paquette B, Orry D, Santucci N, Rat P, Rat P et al. Inflammatory markers as early predictors of infection after colorectal surgery: the same cut-off values in laparoscopy and laparotomy? Int J Colorectal Dis 2017;32:857–863.
- - Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, Panagaki A, Melachroinopoulos N, Drakou E et al. Procalcitonin to Reduce Long-Term Infection-associated Adverse Events in Sepsis. A Randomized Trial. Am J Respir Crit Care Med 2021;203(2):202-210.
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References
- Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015;386:569–624.
- GlobalSurg Collaborative. Mortality of emergency abdominal surgery in high-, middle- and low-income countries. Br J Surg. 2016 Jul;103(8):971-988.
- GlobalSurg Collaborative. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018;18(5):516-525.
- GlobalSurg Collaborative. Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries. BMJ Glob Health 2016;1(4):e000091
- Magagi IA, Adamou H, Habou O, Magagi A, Halidou M, Ganiou K. Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d’une série de 622 patients à l’Hôpital national de Zinder, Niger. Bull Soc Pathol Exot 2017;110(3):191‑197.
- Ngo Nonga B, Mouafo Tambo F, Ngowe Ngowe M, Takongmo S, Sosso M. Etiologies des péritonites aigues généralisées au CHU de Yaoundé. Rev Afr Chi Spéc 2010;7(4):30-32.
- Ouangré E, Zida M, Sawadogo YE, Zaré C, Bazongo M, Sam A et al. Les complications post opératoires précoces des abdomens aigus chirurgicaux dans le service de chirurgie générale et digestive du chu Yalgado Ouédraogo au Burkina Faso : à propos de 98 cas. Rev Afr Chir Spéc 2017;11(3):19‑24.
- Chichom-Mefire A, Fon TA, Ngowe-Ngowe M. Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon. World J Emerg Surg 2016;11(1):14.
- Diedhiou M, Dieng M, Traoré MM, Barboza D, Ba EB, Gaye I et al. Anesthésie-réanimation pour urgences chirurgicales de l’abdomen chez l’adulte : à propos de 118 cas. Rev Afr anesthésiol Med Urgence 2020;25(1):16-21.
- Touré AO, Cissé M, Ka I, Dieng M, Konaté I, Ka 0 , et al. Diffuse post-operative intra-abdominal sepsis: epidemiological, diagnostic and therapeutic aspects at the General Surgery Service of the University Hospital Aristide Le Dantec in Dakar. PAMJ 2014;17,204.
- Ngowe M, Mboudou E, Ngo-Nonga B, Mouafo Tambo F, Ze Minkande J, Bahebeck T et al. Hospital mortality in adult surgical emergencies in Yaounde. J Afr Chir spec 2011; 3 (5):5-8.
- Tonye TA, Essi MJ, Handy ED, Ankouane A, Minka Ngom E, Ngo Nonga B et al. Early Postoperative Complications in the District Hospitals of the City of Yaoundé: Epidemiology and Clinic. Health Sci Dis 2015;16(1):1-4.
- Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum Procalcitonin and C-Reactive Protein Levels as Markers of Bacterial Infection: A Systematic Review and Meta-analysis. Clin Infect Dis 2004;39(2):206–217.
- Naramura T, Imamura H, Yoshimatsu H, Hirashima K, Irie S, Inoue T et al. The Predictive Value of Procalcitonin and High-Sensitivity C-Reactive Protein for Early Bacterial Infections in Preterm Neonates. Neonatology 2021;118:28–36.
- Vasavada B, Patel H. Postoperative serum procalcitonin versus C-reactive protein as a marker of postoperative infectious complications in pancreatic surgery: a meta-analysis. Anz J Surg 2021;91(5):E260-E270.
- Tan WJ, Ng WQ, Sultana R, De Souza NN, Chew MH, Foo FJ et al. Systematic review and meta-analysis of the use of serum procalcitonin levels to predict intra-abdominal infections after colorectal surgery. Int J Colorectal Dis 2018;33(2):171-180.
- Spoto S, Valeriani E, Caputo D, Cella E, Fogolari M, Pesce E et al. The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery: Advantage from daily measurement. Medicine (Baltimore) 2018;97(3):e9496.
- Facy O, Binquet C, Masson D, Fournel I, Rat P, Ortega-deballon P. Diagnostic accuracy of inflammatory markers as early predictors of infection after elective colorectal surgery-results from the IMACORS study. Ann Surg 2015; 263(5): 1– 6.
- Lagoutte N, Facy O, Ravoire A, Chalumeau C, Jonval L, Rat P et al. C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery: pilot study in 100 patients. J Visc Surg 2012;149(5):e345-9.
- Kambire JL, Sanon BG, Zare C, Kambou T. Etiologies et pronostic des urgences chirurgicales digestives au centre Hospitalier Universitaire de Bobo-Dioulasso (Burkina Faso). Rev Afr Chi Spéc 2017;19(3):305-307.
- Mabiala-Babela JR, Pandzou N, Koutaba E, Ganga-Zandzou S, Senga, P. Etude rétrospective des urgences chirurgicales viscérales de l’enfant au CHU de Brazzaville (CONGO). Med Trop 2006;66(2):172-176.
- Tatsuoka T, Okuyama T, Takeshita E, Oi H, Noro T, Mitsui T et al. Early detection of infectious complications using C-reactive protein and the procalcitonin levels after laparoscopic colorectal resection: a prospective cohort study. Surg Today 2021 ;51:397–403.
- Facy O, Paquette B, Orry D, Binquet C, Masson D, Bouvier A et al. Diagnostic Accuracy of Inflammatory Markers As Early Predictors of Infection After Elective Colorectal Surgery: Results From the IMACORS Study. Ann Surg 2016;263:961–966.
- Facy O, Paquette B, Orry D, Santucci N, Rat P, Rat P et al. Inflammatory markers as early predictors of infection after colorectal surgery: the same cut-off values in laparoscopy and laparotomy? Int J Colorectal Dis 2017;32:857–863.
- Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, Panagaki A, Melachroinopoulos N, Drakou E et al. Procalcitonin to Reduce Long-Term Infection-associated Adverse Events in Sepsis. A Randomized Trial. Am J Respir Crit Care Med 2021;203(2):202-210.
- Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med 2017;45(3):486-552.