Predictive value of CRP/albumin ratio in major abdominal surgery
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ORIGINAL ARTICLE
Predictive value of CRP/albumin ratio in major abdominal surgery Noel E. Donlon 1 & Helen Mohan 1 & Ross Free 1 & Badr Elbaghir 1 & Igor Soric 1 & Christina Fleming 1 & Ischwaria Balasubramanian 1 & Ivan Ivanovski 1 & Karl Schmidt 1 & Ken Mealy 1 Received: 17 January 2020 / Accepted: 16 April 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Introduction Surgical site infection (SSI) is a major cause of morbidity, resulting in significant healthcare and economic implications. The ability to predict patients at high risk of SSI may enable targeted follow-up and management. This study sought to examine the relationship between the CRP/albumin ratio in the prediction of SSI in patients undergoing emergency major abdominal surgery. Methods A retrospective study of all patients who underwent emergency major abdominal surgery in our institution over 2 years was performed. Patients were identified from a prospectively maintained database of SSI’s and cross-referenced with hospital records. Patient demographics including age, gender, ASA grade, and wound classification (clean, clean/contaminated, contaminated, and dirty) were collated. Results CRP preoperatively of greater than 5 was statistically significant in predicting an SSI (P < 0.05). In addition, preoperative serum albumin of < 32 was also significant in predicting a superficial site infection. Interestingly, preoperative CRP/albumin ratio did not predict SSI, but postoperative CRP/albumin ratio was predictive at both 24 and 48 hour time points (P < 0.05). Median length of stay in the SSI group was statistically significantly longer at 27.88 days (range 7–76) versus 18.32 days (1–56) (P < 0.01). Conclusions Though CRP and albumin have merit in isolation in preoperative identification of patients at risk of SSI, CRP/ albumin ratio is a useful postoperatively adjunct in predicting SSI postoperatively at 24 and 48hrs postoperatively. Keywords Albumin . CRP . Laparotomy . Major abdominal surgery . Surgical site infection
Introduction Surgical site infections (SSIs) are associated with increased rates of morbidity and mortality, representing a significant healthcare economic burden, and are an independent negative predictor of quality of life [1]. SSIs remain one of the most common healthcare-associated infections (HCAIs), accounting for 15.7% of reported infections [2]. The Centers for Disease Control and Prevention (CDC) defines an SSI as a postoperative infection occurring within 30 days of a surgical procedure and can be subcategorized into superficial (involving the skin and subcutaneous tissue), deep (involving fascial and muscle layers), and organ space [3].
* Noel E. Donlon [email protected] 1
Wexford General Hospital, Co. Wexford, Ireland
In terms of the financial burden, it leads to increased direct and indirect costs from prolonged hospitalization, antibiotic use, wound care, dressings, impaired patient rehabilitation, and multiple clinic [4]. It may also require additional support in the community from other healthcare resources f
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