{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:45:19Z","timestamp":1787237119058,"version":"build-2736575974"},"reference-count":29,"publisher":"Walter de Gruyter GmbH","issue":"3","license":[{"start":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T00:00:00Z","timestamp":1685664000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_pp-2022-0203_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is associated with significant postoperative complications. Early detection of at-risk patients may lead to improved outcomes. The role of C-reactive protein (CRP) in predicting postoperative complications has only been recently investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_pp-2022-0203_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Postoperative complications were categorized according to Clavien-Dindo classification and further divided into minor (Grade &lt;3) and major complications (Grade\u00a0\u22653A). Absolute CRP counts (mg\/L) on postoperative days (POD) 1\u20137, and proportional change in CRP was compared and the area under (AUC) receiver operating characteristics (ROC) curve was calculated. Univariate and multivariate analysis was performed. Significant findings were externally validated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_pp-2022-0203_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-five percent of patients experienced one or more major complications. A CRP level of\u00a0\u2265106\u202fmg\/L on POD 2 and 65.5\u202fmg\/L on POD 4 were significantly associated with an increased risk of major complications with an AUC of 0.658 and 0.672, respectively. The proportional increase in CRP between POD 1 and 4 (\u0394CRP POD 1\/4) at a cut-off of 30\u202f% had the best AUC of 0.744 and was the only independent risk factor for major complications (p&lt;0.0001) on multivariate analysis. \u2206CRP had an AUC of 0.716 (p=0.002) when validated in an independent database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_pp-2022-0203_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CRP can be used in a variety of ways to predict major complications after CRS and HIPEC. However, the \u2206CRP POD 1\/4&gt;30\u202f% is the best indicator of major complications. Serial CRP measurements in the early postoperative period may lead to early detection of patients at risk of major complications allowing for alternative management strategies to improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/pp-2022-0203","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T07:10:27Z","timestamp":1685603427000},"page":"113-121","source":"Crossref","is-referenced-by-count":7,"title":["Early postoperative CRP predicts major complications following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)"],"prefix":"10.1515","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8453-2298","authenticated-orcid":false,"given":"Akash","family":"Kartik","sequence":"first","affiliation":[{"name":"Mayo Clinic , Rochester , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catharina","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Medical University of Vienna , Vienna , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miklos","family":"Acs","sequence":"additional","affiliation":[{"name":"Barmherzige Br\u00fcder Regensburg , Regensburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pompiliu","family":"Piso","sequence":"additional","affiliation":[{"name":"Barmherzige Br\u00fcder Regensburg , Regensburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Starlinger","sequence":"additional","affiliation":[{"name":"Mayo Clinic , Rochester , MN , USA"},{"name":"Medical University of Vienna , Vienna , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Bachleitner-Hofmann","sequence":"additional","affiliation":[{"name":"Medical University of Vienna , Vienna , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7753-097X","authenticated-orcid":false,"given":"Travis E.","family":"Grotz","sequence":"additional","affiliation":[{"name":"Mayo Clinic , Rochester , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2023,6,2]]},"reference":[{"key":"2025120909234411055_j_pp-2022-0203_ref_001","doi-asserted-by":"crossref","unstructured":"Sugarbaker, PH. 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Ann Surg 2004;240:205\u201313. https:\/\/doi.org\/10.1097\/01.sla.0000133083.54934.ae.","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"2025120909234411055_j_pp-2022-0203_ref_008","doi-asserted-by":"crossref","unstructured":"Bartlett, EK, Meise, C, Roses, RE, Fraker, DL, Kelz, RR, Karakousis, GC. Morbidity and mortality of cytoreduction with intraperitoneal chemotherapy: outcomes from the ACS NSQIP database. Ann Surg Oncol 2014;21:1494\u2013500. https:\/\/doi.org\/10.1245\/s10434-013-3223-z.","DOI":"10.1245\/s10434-013-3223-z"},{"key":"2025120909234411055_j_pp-2022-0203_ref_009","doi-asserted-by":"crossref","unstructured":"Foster, JM, Sleightholm, R, Patel, A, Shostrom, V, Hall, B, Neilsen, B, et al.. Morbidity and mortality rates following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy compared with other high-risk surgical oncology procedures. 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Ann Surg Oncol 2020;27:2548\u201356. https:\/\/doi.org\/10.1245\/s10434-019-08117-w.","DOI":"10.1245\/s10434-019-08117-w"},{"key":"2025120909234411055_j_pp-2022-0203_ref_021","doi-asserted-by":"crossref","unstructured":"Ghanim, B, Hoda, MA, Winter, MP, Klikovits, T, Alimohammadi, A, Hegedus, B, et al.. Pretreatment serum C-reactive protein levels predict benefit from multimodality treatment including radical surgery in malignant pleural mesothelioma: a retrospective multicenter analysis. Ann Surg 2012;256:357\u201362. https:\/\/doi.org\/10.1097\/sla.0b013e3182602af4.","DOI":"10.1097\/SLA.0b013e3182602af4"},{"key":"2025120909234411055_j_pp-2022-0203_ref_022","doi-asserted-by":"crossref","unstructured":"Lu, J, Xu, BB, Xue, Z, Xie, JW, Zheng, CH, Huang, CM, et al.. Perioperative CRP: a novel inflammation-based classification in gastric cancer for\u00a0recurrence and chemotherapy benefit. 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