Limits...
C-reactive protein levels in the perioperative period as a predictive marker of endoscopic recurrence after ileo-colonic resection for Crohn ’ s disease

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to determine the perioperative behavior of C-reactive protein (CRP) in Crohn’s disease (CD) patients undergoing elective ileo-cecal (IC) resection and to identify association between perioperative CRP levels and endoscopic recurrence at 1 year. Study hypothesis was that perioperative CRP changes are disease specific and could detect subset of patients with more aggressive pathopysiology. Seventy-five patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed: preoperative, postoperative day 1 (POD1) and day 5 (POD5). CD patients’ values were compared against same interval assessments of control groups undergoing right colectomy and appendicectomy. At POD1, the serum concentration increase was significantly higher in CD patients than in controls. Comparing with control groups, CRP levels remained remarkably high and showed a lower reduction in CD at POD5. Difference between groups was statistically significant. Optimal cutoff levels have been identified: serum CRP concentrations of >39.8 mg/l at POD1 and of >23.2 mg/l at POD5 have shown a significant association to endoscopic recurrence when using bivariate correlation. In this preliminary series, binary logistic regression could not demonstrate statistical relationship between endoscopic recurrence and any of the variables evaluated as prognostic factor. This is the only study so far that investigates and confirms a disease-specific upregulation of CRP response in the perioperative period for CD patients undergoing surgery. The postoperative CRP levels and kinetics seem to be related to the grade of mucosal inflammation and recurrence rate according to our 12 months endoscopic evaluation.

No MeSH data available.


Related in: MedlinePlus

ROC analysis curve for each perioperative serum CRP determination as a predictor of endoscopic recurrence in the test group (n=25). The AUC in the ROC analysis is a measure of the diagnostic performance of a test: an AUC value of ≥50 suggests the ability of a test to significantly differentiate between positive and negative outcomes when classifying by determined variable (endoscopic recurrence as with Rutgeerts’ score ≥2). A diagnostic test with an AUC of >0.75 is deemed to have high diagnostic accuracy. To evaluate the overall ability of perioperative CRP as a prognostic marker for CD recurrence at 12 months and to determine the diagnostic cut preliminary ROC analysis has been performed on a test group of the first 25 consecutive patients of the study population. ROC curves for each different determination timepoints using the calculated CRP cutoffs (specified in Table 2) as possible endoscopic predictors (Rutgeerts’ score ≥2) at 12 months in a test group (first 25 consecutive patients of the study population) are shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4979416&req=5

fig3: ROC analysis curve for each perioperative serum CRP determination as a predictor of endoscopic recurrence in the test group (n=25). The AUC in the ROC analysis is a measure of the diagnostic performance of a test: an AUC value of ≥50 suggests the ability of a test to significantly differentiate between positive and negative outcomes when classifying by determined variable (endoscopic recurrence as with Rutgeerts’ score ≥2). A diagnostic test with an AUC of >0.75 is deemed to have high diagnostic accuracy. To evaluate the overall ability of perioperative CRP as a prognostic marker for CD recurrence at 12 months and to determine the diagnostic cut preliminary ROC analysis has been performed on a test group of the first 25 consecutive patients of the study population. ROC curves for each different determination timepoints using the calculated CRP cutoffs (specified in Table 2) as possible endoscopic predictors (Rutgeerts’ score ≥2) at 12 months in a test group (first 25 consecutive patients of the study population) are shown.

Mentions: However, when considering the kinetics of CRP, the increase between preoperative and postoperative values was significantly higher in CD than in the other control groups accounting for a stronger CRP response (P<0.001) (65.2 mg/l in group A; 13.2 mg/l in group B; 59.3 mg/l in group C) (Figure 3b).


C-reactive protein levels in the perioperative period as a predictive marker of endoscopic recurrence after ileo-colonic resection for Crohn ’ s disease
ROC analysis curve for each perioperative serum CRP determination as a predictor of endoscopic recurrence in the test group (n=25). The AUC in the ROC analysis is a measure of the diagnostic performance of a test: an AUC value of ≥50 suggests the ability of a test to significantly differentiate between positive and negative outcomes when classifying by determined variable (endoscopic recurrence as with Rutgeerts’ score ≥2). A diagnostic test with an AUC of >0.75 is deemed to have high diagnostic accuracy. To evaluate the overall ability of perioperative CRP as a prognostic marker for CD recurrence at 12 months and to determine the diagnostic cut preliminary ROC analysis has been performed on a test group of the first 25 consecutive patients of the study population. ROC curves for each different determination timepoints using the calculated CRP cutoffs (specified in Table 2) as possible endoscopic predictors (Rutgeerts’ score ≥2) at 12 months in a test group (first 25 consecutive patients of the study population) are shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979416&req=5

fig3: ROC analysis curve for each perioperative serum CRP determination as a predictor of endoscopic recurrence in the test group (n=25). The AUC in the ROC analysis is a measure of the diagnostic performance of a test: an AUC value of ≥50 suggests the ability of a test to significantly differentiate between positive and negative outcomes when classifying by determined variable (endoscopic recurrence as with Rutgeerts’ score ≥2). A diagnostic test with an AUC of >0.75 is deemed to have high diagnostic accuracy. To evaluate the overall ability of perioperative CRP as a prognostic marker for CD recurrence at 12 months and to determine the diagnostic cut preliminary ROC analysis has been performed on a test group of the first 25 consecutive patients of the study population. ROC curves for each different determination timepoints using the calculated CRP cutoffs (specified in Table 2) as possible endoscopic predictors (Rutgeerts’ score ≥2) at 12 months in a test group (first 25 consecutive patients of the study population) are shown.
Mentions: However, when considering the kinetics of CRP, the increase between preoperative and postoperative values was significantly higher in CD than in the other control groups accounting for a stronger CRP response (P<0.001) (65.2 mg/l in group A; 13.2 mg/l in group B; 59.3 mg/l in group C) (Figure 3b).

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to determine the perioperative behavior of C-reactive protein (CRP) in Crohn&rsquo;s disease (CD) patients undergoing elective ileo-cecal (IC) resection and to identify association between perioperative CRP levels and endoscopic recurrence at 1 year. Study hypothesis was that perioperative CRP changes are disease specific and could detect subset of patients with more aggressive pathopysiology. Seventy-five patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed: preoperative, postoperative day 1 (POD1) and day 5 (POD5). CD patients&rsquo; values were compared against same interval assessments of control groups undergoing right colectomy and appendicectomy. At POD1, the serum concentration increase was significantly higher in CD patients than in controls. Comparing with control groups, CRP levels remained remarkably high and showed a lower reduction in CD at POD5. Difference between groups was statistically significant. Optimal cutoff levels have been identified: serum CRP concentrations of &gt;39.8&thinsp;mg/l at POD1 and of &gt;23.2&thinsp;mg/l at POD5 have shown a significant association to endoscopic recurrence when using bivariate correlation. In this preliminary series, binary logistic regression could not demonstrate statistical relationship between endoscopic recurrence and any of the variables evaluated as prognostic factor. This is the only study so far that investigates and confirms a disease-specific upregulation of CRP response in the perioperative period for CD patients undergoing surgery. The postoperative CRP levels and kinetics seem to be related to the grade of mucosal inflammation and recurrence rate according to our 12 months endoscopic evaluation.

No MeSH data available.


Related in: MedlinePlus