• Yasser Al-Jabi and Amr El-Shawarby.
• School of Surgery, Royal College of Surgeons, 123 St. Stephen Green, Dublin 2, Republic of Ireland. yasseraljabi@rcsi.ie
• Br J Neurosurg. 2010 Dec 1; 24 (6): 653-9.

AimThe aim of this manuscript is to review the current state of knowledge regarding C-reactive protein (CRP) kinetics after standard neurosurgical procedures, and to determine the value of CRP as a screening test for early post-operative infectious complications as opposed to other more commonly used tests, and as a marker of peri-operative surgical insult.MethodsOver 18 months period, CRP levels, alongside with ESR and WCC were assessed pre-operatively (at day 0) and post-operatively (at days 1,2,3,4 and 5) in 50 consecutive female patients and 50 consecutive male patients undergoing seven neurosurgical procedures. Each of the seven procedures involved a different level of intra-operative trauma. Factors of possible influences on CRP, including volume of blood transfused intra-operatively, type of anaesthetic administered, use of anti-inflammatory drugs and antibiotics levels were recorded.ResultsThe median age of our study population was 29.1 (mean ± SD: 28.4 ± 10.2; range: 20.4-53.8). Of the 100 patients recruited for our study, 13 developed post-operative infectious complications. In these patients, a secondary CRP rise or failure to decrease as expected had sensitivity, specificity, negative and positive predictive value of 100%, 93.1%, 100% and 68.4%, respectively, for detecting infectious complications. The mean post-operative CRP levels were highest in the most surgically traumatic procedure--lobotomy for epilepsy intervention, and lowest in the least surgically traumatic procedure--stereotactic brain biopsy (p < 0.001). Volume of blood transfused intra-operatively, type of anaesthetic administered, use of anti-inflammatory drugs and antibiotics levels did not affect CRP kinetics.ConclusionThe results of this study suggest that CRP is a more reliable screening test for post-operative infectious complications in the practice of neurosurgery than other more commonly used tests (WCC and ESR). Furthermore, the results suggest that peak post-operative CRP levels mirrors the level of incurred intra-operative surgical insult.

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