LAUSR

a value superior to that peak at any point during the subsequent postoperative course would be manifesting additional inflammation produced by an infectious complication. Based on this thesis, we propose a different approach for the use of CRP in which for each subject, his or her own postoperative peak is used as a self-reference value, comparing the value on the day on which an infectious complication is suspected with the value presented at 48 hours (peak). This practice has been reported useful in two retrospective studies, showing good diagnostic accuracy (90.7%) and performance (sensitivity 82.9%, specificity 93.4%, PPV 81.0%, and negative predictive value 94.2%) in the case of anastomotic leak/intraabdominal abscess. We are conscious of the limitations of these studies; nonetheless, data are sufficiently convincing to suggest that no patient should be discharged with a CRP value superior to or approaching his or her peak value. Furthermore, patients meeting this condition at any time during the postoperative period should be carefully evaluated for an infectious complication, a practice which could be particularly beneficial in pauci symptomatic patients. This might also be employed as an additional criterion of discharge protocols after surgery. Conversely to CRP, this methodology has never been assessed for PCT. This sepsis marker presents its postoperative peak at 24 hours and then progressively drops. According to our proposal, the value of PCT at 24 hours might be used as a self-reference, with any higher value from the second postoperative day onward reflecting a possible infectious complication. PCT’s specificity for septic conditions makes it especially suitable for use in this novel approach. In short, the assessment of inflammatory markers on an individual basis could be an easier and more reliable method to use these parameters to detect/predict postoperative infectious complications. In our opinion, this alternative approach to the use of CRP and PCT, which could potentially be applied in any surgical procedure and patient, deserves further consideration in prospective settings to confirm its utility and predictive/diagnostic capacity.