C-reactive protein levels in combination with abdominal CT scans is a useful tool to predict the macroscopic appearance in late-stage EPS patients prior to surgery

Abstract

Daniel Kitterer,1 Stephan Segerer,2 Wolfgang Steurer,3 Juergen Dippon,4 Angela Geissler,5 Christoph Ulmer,3 Niko Braun,1 Mark Dominik Alscher,1 Joerg Latus1 1Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; 2Division of Nephrology, University Hospital, Zurich, Switzerland; 3Department of General, Visceral and Trauma Surgery, Robert-Bosch-Hospital, 4Department of Mathematics, University of Stuttgart, 5Department of Radiology and Nuclear Medicine, Robert-Bosch-Hospital, Stuttgart, GermanyBackground: Diagnosis of encapsulating peritoneal sclerosis (EPS) is based on clinical symptoms, radiologic findings, and macroscopic or histological criteria. Two diagnostic scores for radiologic findings in computed tomography (CT) scans of patients with EPS have been established in the past (by Tarzi et al and Vlijm et al). The macroscopic appearance of EPS has previously been separated into three types. The use of CT scan as a tool to predict different macroscopic phenotypes, leading to specific surgical techniques and different medical treatment, has not yet been investigated.Methods: We retrospectively analyzed 30 patients with late-stage EPS who underwent major surgery with peritonectomy and enterolysis. The preoperative CT scans were scored according to the two aforementioned established diagnostic CT scores. The macroscopic phenotype, surgical procedure, and laboratory values at the time of surgery were evaluated. CT findings in the different macroscopic phenotypes were analyzed.Results: All patients had highly predictive CT scores for EPS. The macroscopic Type III had significantly higher CT scores compared with the other macroscopic phenotypes. Patients with macroscopic Type I had significantly higher C-reactive protein values compared to EPS Type III. Operation time was significantly longer, and repeated surgery and intraoperative complications were more frequent in EPS Type I compared with EPS Type III (P<0.05). Using the CT score and CRP level, the sensitivities for prediction of EPS I and III were 78% and 87% with corresponding specificities of 67% and 93%.Conclusion: Abdominal CT scans might help to identify patients with a higher risk of complications and provide important information for the surgical intervention prior to surgery. Keywords: encapsulating peritoneal sclerosis, peritoneal dialysis, macroscopic phenotype, peritonectomy and enterolysis, PEEL, intraoperative findings, medical therapy in EPS