Predictive value of CRP/albumin ratio in major abdominal surgery

Introduction: Surgical site infection (SSI) is a major cause of morbidity, resulting in significant healthcare and economic implications. The ability to predict patients at high risk of SSI may enable targeted follow-up and management. This study sought to examine the relationship between the CRP/albumin ratio in the prediction of SSI in patients undergoing emergency major abdominal surgery.

Methods: A retrospective study of all patients who underwent emergency major abdominal surgery in our institution over 2 years was performed. Patients were identified from a prospectively maintained database of SSI's and cross-referenced with hospital records. Patient demographics including age, gender, ASA grade, and wound classification (clean, clean/contaminated, contaminated, and dirty) were collated.

Results: CRP preoperatively of greater than 5 was statistically significant in predicting an SSI (P < 0.05). In addition, preoperative serum albumin of < 32 was also significant in predicting a superficial site infection. Interestingly, preoperative CRP/albumin ratio did not predict SSI, but postoperative CRP/albumin ratio was predictive at both 24 and 48 hour time points (P < 0.05). Median length of stay in the SSI group was statistically significantly longer at 27.88 days (range 7-76) versus 18.32 days (1-56) (P < 0.01).

Conclusions: Though CRP and albumin have merit in isolation in preoperative identification of patients at risk of SSI, CRP/albumin ratio is a useful postoperatively adjunct in predicting SSI postoperatively at 24 and 48hrs postoperatively.