Tests for monitoring the acute-phase response to surgery

Abstract

We have investigated the efficacy of laboratory tests for monitoring the acute-phase response in 54 patients who underwent elective abdominal surgery. Post-operative changes in slow responding acute-phase proteins such as fibrinogen were monitored by erythrocyte sedimentation rate and plasma viscosity in all patients and by erythrocyte aggregation and disaggregation in 22 patients. These tests were of limited efficacy as they were also influenced by the post-operative fall in haematocrit and/or albumin. Of faster responding acute-phase proteins, the blood concentrations of interleukin-1, interleukin-6 and tumour necrosis factor had largely returned to normal pre-operative values within 24 hours of surgery. C-reactive protein showed a more appropriate time course, but its extreme sensitivity to the surgical procedure (1400% rise in blood concentration on day 3) would limit its value for the detection of post-operative complications. Existing tests for monitoring the acute-phase response are not recommended for the routine detection of post-operative complications.