Early CRP kinetics predict surgical outcomes in patients with Hartmann reversal

TL;DR

This study shows that changes in C-reactive protein levels in the first three days after surgery can predict outcomes for patients undergoing Hartmann reversal.

Contribution

The study introduces ΔCRP as a novel predictor of surgical success in Hartmann reversal patients.

Findings

ΔCRP was significantly higher in patients with complications compared to those without.

A ΔCRP cutoff of 113.1 mg/L predicted surgical success with an AUC of 0.754.

ΔCRP was confirmed as an independent predictor of surgical success using logistic regression.

Abstract

Hartmann reversal (HR) is associated with considerable morbidity, and early identification of patients at risk of complications is crucial. C-reactive protein (CRP) is a well-established inflammatory biomarker, but its dynamic changes (ΔCRP) as a predictor of surgical success in HR remain unclear. This study evaluates the role of ΔCRP between postoperative days 1 and 3 in predicting surgical outcomes.

A retrospective observational study was conducted on patients undergoing HR at a tertiary hospital between January 2023 and December 2024. Demographic, clinical, and surgical data were collected. ΔCRP was defined as the absolute difference between CRP levels on postoperative days 1 and 3. Surgical success was defined as the absence of major complications, no need for reoperation, and discharge within the expected recovery period. Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve analysis to determine the predictive value of ΔCRP.

A total of 83 patients were included. ΔCRP was significantly higher in patients with complications (56 vs. 136 mg/L, p < 0.001). ROC analysis identified an optimal ΔCRP cutoff of 113.1 mg/L for predicting surgical success (AUC = 0.754). Logistic regression confirmed ΔCRP as an independent predictor of success (OR: 1.015, 95% CI: 1.010–1.020, p < 0.001).

ΔCRP is a valuable predictor of surgical success in HR. Patients with persistently elevated CRP levels may benefit from closer monitoring and early interventions. Integrating CRP kinetics into postoperative protocols could optimize patient outcomes and resource allocation.

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