Key result
A postoperative C-reactive protein to albumin ratio ≥2.2 was an independent risk factor for postoperative complications after colorectal surgery (OR 4.413), with higher diagnostic accuracy than CRP.
Why the study?
Does the postoperative C-reactive protein to albumin ratio predict postoperative complications better than CRP alone in patients undergoing colorectal surgery?
Observational (n=359)
No
Does the postoperative C-reactive protein to albumin ratio predict postoperative complications better than CRP alone in patients undergoing colorectal surgery?
Odds Ratio: 4.413 (95% CI 2.463–7.906)
Absolute Event Rate: 60.8% vs 18.6%
p-value: p=<0.001
The postoperative C-reactive protein to albumin ratio on day 3 is a more accurate predictor of postoperative complications than CRP alone in patients undergoing colorectal surgery.
May aid complication prediction after colorectal surgery; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: The ratio of C-reactive protein to albumin, as a novel inflammation-based prognostic score, is associated with outcomes in cancer and septic patients. The diagnostic accuracy of the CRP/albumin ratio has not been assessed in colorectal surgery for postoperative complications. METHODS: A total of 359 patients undergoing major colorectal surgery between 2012 and 2015 were eligible for this study. Uni- and multivariate analyses were performed to identify risk factors for postoperative complications. Receiver operating characteristic curves were developed to examine the cutoff values and diagnostic accuracy of the CRP/albumin ratio and postoperative CRP levels. RESULTS: Among all the patients, 139 (38.7%) were reported to have postoperative complications. The CRP/albumin ratio was an independent risk factor for complications (OR 4.413; 95% CI 2.463-7.906; P < 0.001), and the cutoff value was 2.2, which had a higher area under the curve compared to CRP on postoperative day 3 (AUC 0.779 vs 0.756). The CRP/albumin ratio also had a higher positive predictive value than CRP levels on postoperative day 3. Patients with CRP/albumin ≥2.2 suffered more postoperative complications (60.8% vs 18.6%, P < 0.001), longer postoperative stays (10 (4-71) vs 7 (3-78) days, P < 0.001), and increased surgical site infections (SSIs) (21.1% vs 4.8%, P < 0.001) than those with CRP/albumin <2.2. CONCLUSIONS: The ratio of C-reactive protein to albumin could help to identify patients who have a high probability of postoperative complications, and the ratio has higher diagnostic accuracy than C-reactive protein alone for postoperative complications in colorectal surgery.
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Ge et al. (2017) conducted an observational in Colorectal surgery (n=359). Postoperative C-reactive protein to albumin ratio (CAR) ≥2.2 vs. CAR <2.2 was evaluated on Overall postoperative complications (Clavien-Dindo classification) (OR 4.413, 95% CI 2.463-7.906, p=<0.001). A postoperative C-reactive protein to albumin ratio ≥2.2 was an independent risk factor for postoperative complications after colorectal surgery (OR 4.413), with higher diagnostic accuracy than CRP.
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