INCOMPLETE OR ABSENT ACUTE-PHASE RESPONSE IN SOME POSTOPERATIVE-PATIENTS

In a prospective study, 74 patients were admitted for an open fracture of the lower limb and treated by osteosynthesis. None of them present ed infectious complication during the postoperative period. Among them , 67 exhibited a classical acute phase response. In 5 patients, the re sponse was apparently incomplete since no serum C-reactive protein (CR P) rise was observed after the injury; i.e. CRP concentrations remaine d inferior to the detection limit of the assay used; in contrast, seru m alpha-1 acid glycoprotein (AAG) concentrations were temporarily incr eased, a variation associated with a concomitant decrease of transthyr etin (TTR) concentration. In 2 other patients, CRP and AAG levels were not significantly modified. The 7 patients did not suffer hepatic ins ufficiency or protein malnutrition. In our series, incomplete or absen t acute phase response was not rare (prevalence 9%) and was not relate d to an increased risk of postoperative infection. Tn contrast to CRP, the TTR response, i.e. a transitory decrease, was observed in all the 7 patients. (C) 1997 Elsevier Science B.V.