SCREENING OF CONCENTRATIONS OF C-REACTIVE PROTEIN AND VARIOUS PLASMA PROTEASE INHIBITORS PREOPERATIVELY FOR THE PREDICTION OF POSTOPERATIVECOMPLICATIONS

Objective: To find out whether concentrations of albumin (reflecting n utritional state), C-reactive protein (reflecting an acute phase react ion) or plasma protease inhibitors (reflecting ongoing proteolysis) ar e good predictors of postoperative complications, and whether other bi ochemical tests may improve diagnostic accuracy. Design: Retrospective study. Setting: University hospital, Sweden. Subjects: 260 patients u ndergoing elective surgery for malignant (n = 149) or benign (n = 111) disease. Main outcome measures: Preoperative biochemical plasma measu rements and postoperative complications. Results: 192 patients recover ed uneventfully and 35 had minor and 33 major postoperative complicati ons. An increased plasma C-reactive protein concentration preoperative ly, as well as a reduced albumin concentration, predicted the risk of developing major postoperative complications. Measurement of plasma pr otease inhibitors (C1-esterase inhibitor, alpha-2-macroglobulin and an tithrombin III), specific biochemical studies of microheterogeneity, o r comparison of quantitative and functional concentrations of the inhi bitors gave no additional information. Conclusion: One measurement of the C-reactive protein and albumin concentrations preoperatively will identify patients at risk of developing severe postoperative complicat ions.