Open AccessThe effect of the visceral fat area on the predictive accuracy of C‐reactive protein for infectious complications after laparoscopy‐assisted gastrectomy
Author(s) -
Iida Michihisa,
Takeda Shigeru,
Nakagami Yuki,
Kanekiyo Shinsuke,
Nakashima Chiyo,
Nishiyama Mitsuo,
Yoshida Shin,
Suzuki Nobuaki,
Yoshino Shigefumi,
Nagano Hiroaki
Publication year - 2020
Publication title -
annals of gastroenterological surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.308
H-Index - 15
ISSN - 2475-0328
DOI - 10.1002/ags3.12329
Subject(s) - medicine , quartile , c reactive protein , visceral fat , laparoscopy , gastroenterology , surgery , inflammation , insulin resistance , obesity , confidence interval
Aim To investigate the influence of visceral fat area on postoperative C‐reactive protein levels and whether it affects its ability to diagnose infectious complications after laparoscopy‐assisted gastrectomy. Methods A total of 435 consecutive patients who underwent laparoscopy‐assisted resection for gastric cancer from 2008 to 2017 were reviewed and divided into four groups according to visceral fat area quartiles. We evaluated the relationship between C‐reactive protein and visceral fat area and whether visceral fat area affects the sensitivity and specificity of C‐reactive protein in diagnosing postoperative infectious complications. Results Postoperative C‐reactive protein levels increased with increasing visceral fat areas at every postoperative assessment. Multiple linear regression revealed that levels on postoperative day 3 significantly positively correlated with visceral fat area. Postoperative day 3 levels also showed moderate accuracy for diagnosing infectious complications (area under the curve, 0.78; sensitivity, 0.86; specificity, 0.65), with an optimal cut‐off of 11.8 mg/dL. The sensitivity for predicting infectious complications was low in the 1st visceral fat area quartile group but high in the 2nd, 3rd, and 4th groups (0.43 vs 1.0 vs 1.0 vs 0.94, respectively). By contrast, the specificity was high in the 1st and 2nd group but low in the 3rd and 4th (0.84 vs 0.70 vs 0.54 vs 0.48, respectively). Conclusion Visceral fat area positively correlated with postoperative C‐reactive protein levels and this affected its accuracy in diagnosing infectious complications. A uniform C‐reactive protein cut‐off may not provide accurate predictions in patients with more extreme visceral fat areas.