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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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Guy Aristide, B., Joachim, T., Olivier, F. K., Victor Fabrice, W. M., & Vicky Joceline, A. M. (2022). Early Detection of Infectious Complications After Laparotomy for Acute Digestive Abdomen Using C-Reactive Protein and Procalcitonin: A Prospective Multicentre Analysis in Yaoundé. HEALTH SCIENCES AND DISEASE, 23(4). https://doi.org/10.5281/hsd.v23i4.3199
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