DO SERUM ACUTE PHASE REACTANTS PREDICT CLINICAL OUTCOME IN EMERGENCY GENERAL SURGICAL ADMISSIONS?

Authors

  • Saad Ullah Khan Dudley Group NHS Foundation Trust, Pensnett road, Dudley, West Midlands, DY1 2HQ, United Kingdom.
  • Jun Yi Soh Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK
  • Aikaterini Peleki Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK
  • Muhammad Abdullah Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK
  • Shafquat Zaman Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK
  • Peter William Waterland Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK

Abstract

Background: Identifying general surgical patients at risk of poor outcome can be a diagnostic challenge. This study aimed to determine the significance of admission serum acute phase reactants in predicting emergency general surgical outcome. Methods: An electronic database containing all acute general surgical admissions over two years was analysed to correlate admission acute phase reactants (including C-reactive protein (CRP), absolute neutrophil count (ANC) and serum albumin) with outcome. Study endpoints included: cross-sectional imaging, surgery, intensive care admission, in-hospital mortality and length-of-stay (LOS). Results: A total of 9738 patients were enrolled in the study. Elevated CRP (n= 4635; 47%) was associated with:  advanced imaging 17% vs 30% (p=0.0001), surgery 15% vs 28% (p=0.0001), ITU admission 3% vs 7% (p=0.0001) and mortality 0.5% vs 2% (p=0.0001). A cut-off level of >150 mg/L was most significant. Abnormal ANC (n= 4104; 42%) was significant in predicting advanced imaging 15% vs 55% (p=0.0001), surgery 17% vs 27% (p=0.0001), and ITU admission 3% vs 8% (p=0.0001). Hypoalbuminaemia (n= 1392; 14%) was associated with a 12-fold rise in mortality 0.5% vs 6%. Normal CRP, ANC with hypoalbuminaemia was a strong negative predictor of mortality (0.015% vs 1.24%), while an abnormal combination was associated with mortality of 8%. Conclusion: Admission acute phase reactants are useful to enhance acute surgical patient stratification during clinical decision making. An admission CRP above 150 should alert the clinician of a potentially high-risk patient who may require prompt intervention. A combination of abnormal results has the highest in-hospital mortality.Keywords: General surgery; C-reactive protein; Serum albumin; Neutrophils; Acute abdomen; Emergency Treatment

Author Biographies

Saad Ullah Khan, Dudley Group NHS Foundation Trust, Pensnett road, Dudley, West Midlands, DY1 2HQ, United Kingdom.

Consultant, General and Upper GI Surgery

Jun Yi Soh, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK

Clinical Teaching Fellow, Honorary Clinical Lecturer, University of Birmingham

Aikaterini Peleki, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK

Specialist Registrar, General surgery

Muhammad Abdullah, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK

Consultant, Breast and General Surgeon

Shafquat Zaman, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK

Specialist Registrar in General Surgery

Peter William Waterland, Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley West Midlands, DY1 2HQ, UK

Consultant, General and Colorectal Surgery

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Published

2018-09-19