Observational study to predict gut gangrene from raised serum C reactive protein levels in intestinal obstruction cases
DOI:
https://doi.org/10.18203/2349-2902.isj20251172Keywords:
C reactive protein, Gut gangrene, Strangulated obstruction, Predictive biomarkersAbstract
Background: Intestinal obstruction can progress to bowel gangrene, increasing morbidity and mortality. Early diagnosis and decision taking for intervention remains challenging. This study evaluated serum C-reactive protein (CRP) as a predictive marker for gangrene in intestinal obstruction.
Methods: A prospective observational study was conducted on 110 patients with surgically managed intestinal obstruction at SMS Hospital, Jaipur. Serum CRP levels at admission were recorded and correlated with intraoperative findings. Statistical analysis included ROC curve for determining predictive value.
Results: Bowel gangrene was found in 30% of cases. Mean CRP levels were significantly higher in gangrene cases (121 mg/l) vs. non-gangrene (12 mg/l) (p<0.001). A CRP cut-off of 43.05 mg/l showed 93.9% sensitivity and 96.1% specificity. Delays >48 hours from symptom onset to surgery significantly increased gangrene risk (p=0.008).
Conclusions: Serum CRP is a valuable, accessible biomarker for early detection of gut gangrene in intestinal obstruction, aiding timely surgical intervention. Further studies with serial CRP measurements are recommended.
Metrics
References
Malik AM, Shah M, Pathan R, Sufi K. Pattern of Acute intestinal obstruction. Saudi J Gastroenterol. 2010;16(4):272-4. DOI: https://doi.org/10.4103/1319-3767.70613
Yeo CJ. Shackelford surgery of the Aliementary tract. 8th edition. Elsevier; 2017.
Xu W, Zhong Q, Cai Y, Zhan C, Chen S, Wang H, et al. Prediction and management of strangulated bowel obstruction: a multi-dimensional model analysis. BMC Gastroenterol. 2022;22(1):304. DOI: https://doi.org/10.1186/s12876-022-02363-1
Knight ML. The application of high-sensitivity C-reactive protein in clinical practice: a 2015 update. Cardiovascular. 2020.
Li PH, Tee YS, Fu CY, Liao CH, Wang SY, Hsu YP, et al. The role of noncontrast CT in the evaluation of surgical abdomen patients. Am Surg. 2018;84(6):1015-21. DOI: https://doi.org/10.1177/000313481808400658
Mengozzi M, Kirkham FA, Girdwood EER, Bunting E, Drazich E, Timeyin J, et al. C-reactive protein predicts further ischemic events in patients with transient ischemic attack or lacunar stroke. Front Immunol. 2020;11:1403. DOI: https://doi.org/10.3389/fimmu.2020.01403
Lee Y, McKechnie T, Doumouras AG, Handler C, Eskicioglu C, Gmora S, et al. Diagnostic value of c-reactive protein levels in postoperative infectious complications after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2019;29(7):2022-9. DOI: https://doi.org/10.1007/s11695-019-03832-5
Markogiannakis H, Memos N, Messaris E, Dardamanis D, Larentzakis A, Papanikolaou D, et al. Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery. 2011;149(3):394-403. DOI: https://doi.org/10.1016/j.surg.2010.08.007
Demir IE, Ceyhan GO, Friess H. Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg. 2012;29(3):226-35. DOI: https://doi.org/10.1159/000338086
Lin YP, Lee J, Chao HC, Kong MS, Lai MW, Chen CC, et al. Risk factors for intestinal gangrene in children with small-bowel volvulus. Pediatr Gastroenterol Nutr. 2011;53(4):417. DOI: https://doi.org/10.1097/MPG.0b013e3182201a7c
Thakur DS, Tiwari C, Somashekar U, Kothari R, Sharma D. Serum CRP: a marker of bowel gangrene in acute intestinal obstruction. J Med Sci Clin Res. 2018;6(4):998-1004. DOI: https://doi.org/10.18535/jmscr/v6i4.164
Dhoon R, Kumawat S, Soni ML, Rohella MK, Sharma V, Karosia V, et al. A prospective study of serum C-reactive protein and D-lactate levels for early prediction of strangulation in intestinal obstruction. Int J Surg. 2019;6(7):2510-3. DOI: https://doi.org/10.18203/2349-2902.isj20192983
Springer JE, Bailey JG, Davis PJ, Johnson PM. Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study. Can J Surg. 2014;57(6):379-84. DOI: https://doi.org/10.1503/cjs.029513
Kittaka H, Akimoto H, Takeshita H, Funaoka H, Hazui H, Okamoto M, et al. Usefulness of intestinal fatty acid-binding protein in predicting strangulated small bowel obstruction. PLoS One. 2014;9(6):99915. DOI: https://doi.org/10.1371/journal.pone.0099915
Downloads
Published
How to Cite
Issue
Section
