Acute-phase changes in children recovering from minor surgery

The metabolic response to surgical stress is a nonspecific increase in hepa tic synthesis of some specialized acute-phase proteins and a decrease in pl asma concentrations of visceral proteins following surgical trauma. This st udy was undertaken determine which specific proteins were the better clinic al indices in monitoring the metabolic response to surgical stress in child ren recovering from minor surgery. Forty-four patients undergoing elective inguinal surgical procedures under general anesthesia were studied. Blood s amples were collected preoperatively (-1) and at 1(+1) and 5(+5) days posto peratively to determine albumin (AL), Prealbumin (PA), C-reactive protein ( CRP), and al-acid glycoprotein (AGP) values, and to calculate the prognosti c inflammatory and nutritional index (PINI). Mean AL values were the same o n all days. Mean PA +1 was significantly lower than PA -1 and PA +5 (P < 0. 001). Median CRP +1 and mean AGP +1 values were significantly higher than m edian CRP -1 and mean AGP -1 (P < 0.0001), respectively. Although there was a decrease after postoperative day i, median CRP + 5 and mean AGP + 5 valu es were still significantly higher than preoperative values (P < 0.01 and P < 0.0001). Moreover, the median PINI + 1 was also greater than PINI -1 and PINI +5 (P < 0.0001), but the median PINI+5 was significantly higher than PINI -1 (P < 0.01). Median percent changes of PINI values were significantl y higher than those of the other parameters from both preoperatively to pos toperative day I and preoperatively to postoperative day 5. Although severa l specific proteins (AL, PA, CRP, and AGP) have been evaluated as indicator s of the acute metabolic response, we suggest that the PINI is more valuabl e for reflecting the response to surgical stress in patients recovering fro m minor surgery.