Association of CRP, Procalcitonin, Lactate, and Albumin Levels with In-Hospital Mortality Post-Definitive Laparotomy in Patients with Complicated Intra-Abdominal Infections

Abstract

Introduction: Complicated intra-abdominal infection (cIAI) still has a high mortality rate due to organ dysfunction despite advances in supportive care. Unlike other sources of septicemia, cIAI requires source control surgery, which is crucial for improving outcomes. The strategy for source control varies depending on the degree of inflammation associated with cIAI; the more severe the inflammation, the less aggressive the surgery needs to be. Therefore, we need a reliable parameter to predict the degree of inflammation before any physiological rearrangement or organ dysfunction occurs due to excessive inflammation from surgery. The literature shows that CRP, procalcitonin, lactate, and albumin are associated with the degree of inflammation. Thus, it’s necessary to study about mentioned parameters for being reference determination strategy of surgery in cIAI, classical definitive laparotomy, or rapid source control laparotomy (RSCL). Methods: We have collected data from CIAI patients at Dr. Soetomo Regional General Hospital in Surabaya, Indonesia, covering November 2022 to April 2024. Our primary focus is assessing the inflammation level associated with the compensated or decompensated phase. The decompensated phase signifies an excessive inflammatory response, with one indication being in-hospital mortality. Subsequently, we performed univariate and multivariate analyses using the SPSS program to determine which laboratory parameters (CRP, Procalcitonin, Lactate, and Albumin) are most associated with in-hospital mortality. Results: Between November 2022 and April 2024, there were 309 patients with complicated intra-abdominal infections (cIAI). Among the patients, 61.8% were male and 38.2% were female. The majority of patients (27.17%) were aged 61-70. The causes of cIAI included perforated appendicitis (22.65%), perforated peptic ulcer (21.69%), complications from previous surgeries (18.13%), large bowel perforation (12.29%), small bowel perforation (11.33%), intraperitoneal abscess (11.33%), and other causes (2.58%). Statistically, lactate was found to be the most accurate predictor of intraoperative hemodynamic instability (p-value < 0.001; correlation coefficient of 0.481), followed by albumin (p-value < 0.001; correlation coefficient of 0.357). CRP and Procalcitonin were less accurate, with correlation coefficients of 0.182 and 0.272, respectively. The determined cut-off points for lactate and albumin were 1.94 and 2.73, for CRP and Procalcitonin were 23,24 and 47,95. Abnormal laboratory finding in our study mean CRP above cut off point, Procalcitonin above cut off point, lactate above cut off point and albumin below cut off point. More than 2 laboratories finding, in-hospital mortality 66,7%, 2 laboratory finding in-hospital mortality 42,8% and only 1 laboratory finding in-hospital mortality 28,4%. Conclusions: CRP, Procalcitonin, Lactate and Albumin have relation statistically significant with in-hospital mortality. Lactate and albumin are better than CRP and procalcitonin in our study, and consider RSCL for more than 2 parameter abnormal laboratory findings CRP, procalcitonin, lactate or albumin. Keywords: Complicated intraabdominal infection, Inflammatory mediators, Damage control laparotomy