International Journal of Colorectal Disease

, Volume 33, Issue 7, pp 947–953 | Cite as

Glasgow prognostic score is a practical predictive index for postoperative intra-abdominal septic complications after bowel resection in Crohn’s disease patients

  • Yibin Zhu
  • Haili Xu
  • Wei Liu
  • Weilin Qi
  • Xiaoyan Yang
  • Lingna Ye
  • Qian Cao
  • Wei Zhou
Original Article



Postoperative intra-abdominal septic complications (IASCs) are not uncommon in patients with Crohn’s disease (CD). The appropriate index to predict postoperative IASCs in these individuals remains unknown. This study investigates whether the inflammation-based Glasgow prognostic score (GPS) is predictive in the setting of postoperative IASC CD patients who underwent elective bowel resection.


A consecutive cohort of 163 CD patients who underwent elective intestinal resection from July 2012 to March 2016 was retrospectively analyzed. Patients were divided into two GPS groups, one lower and one higher. The GPS was defined by serum levels of C-reactive protein and albumin. Univariate and multivariate analyses were conducted to identify risk factors for postoperative IASCs.


Postoperative IASCs occurred in 25 (15.3%) patients. Compared with patients in the lower GPS group, patients with a higher GPS had a higher incidence of postoperative IASCs (9.85 vs. 38.71%, P < 0.001) and experienced longer postoperative hospital stay (10.53 ± 7.00 vs. 15.71 ± 9.17, P = 0.001). Univariate and multivariate analyses revealed preoperative GPS [odds ratio (OR) 5.016, 95% confidence interval (CI) 1.134–22.193, P = 0.034] and penetrating behavior (OR 4.495, 95% CI 1.377–14.670, P = 0.013) to be independent risk factors for postoperative IASCs.


A preoperative GPS can serve as a useful index for predicting manifestation of postoperative IASCs after bowel resection in patients with CD. Perioperative optimization is required to improve postoperative outcomes for patients with higher GPS.


Crohn’s disease Glasgow prognostic score Postoperative complications Bowel resection Penetrating disease 



This study was supported by the Zhejiang Provincial Natural Science Foundation of China under Grant No. LY18H030006 and the Jie-Shou Li’s Special Foundation for intestinal mucous barrier (award number LJS-201603).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Hart AL, Ng SC (2011) Crohn’s disease. Medicine 39(4):229–236CrossRefGoogle Scholar
  2. 2.
    Nandivada P, Poylin V, Nagle D (2012) Advances in the surgical management of inflammatory bowel disease. Curr Opin Gastroenterol 28(1):47–51CrossRefPubMedGoogle Scholar
  3. 3.
    Cosnes J, Nion-Larmurier I, Beaugerie L, Afchain P, Tiret E, Gendre JP (2005) Impact of the increasing use of immunosuppressants in Crohn's disease on the need for intestinal surgery. Gut 54(2):237–241CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bernell O, Lapidus A, Hellers G (2000) Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg 231(1):38–45CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Landsend E, Johnson E, Johannessen HO, Carlsen E (2006) Long-term outcome after intestinal resection for Crohn’s disease. Scand J Gastroenterol 41(10):1204–1208CrossRefPubMedGoogle Scholar
  6. 6.
    Iesalnieks I, Kilger A, Glass H et al (2008) Intraabdominal septic complications following bowel resection for Crohn’s disease: detrimental influence on long-term outcome. Int J Color Dis 23(12):1167–1174CrossRefGoogle Scholar
  7. 7.
    Kanazawa A, Yamana T, Okamoto K, Sahara R (2012) Risk factors for postoperative intra-abdominal septic complications after bowel resection in patients with Crohn’s disease. Dis Colon Rectum 55(9):957–962CrossRefPubMedGoogle Scholar
  8. 8.
    Morar PS, Hodgkinson JD, Thalayasingam S, Koysombat K, Purcell M, Hart AL, Warusavitarne J, Faiz O (2015) Determining predictors for intra-abdominal septic complications following ileocolonic resection for Crohn’s disease-considerations in pre-operative and peri-operative optimisation techniques to improve outcome. J Crohns Colitis 9(6):483–491CrossRefPubMedGoogle Scholar
  9. 9.
    Zuo L, Li Y, Wang H, Zhu W, Zhang W, Gong J, Li N, Li J (2015) A practical predictive index for intra-abdominal septic complications after primary anastomosis for Crohn’s disease: change in C-reactive protein level before surgery. Dis Colon Rectum 58(8):775–781CrossRefPubMedGoogle Scholar
  10. 10.
    Zhang M, Gao X, Chen Y, Zhi M, Chen H, Tang J, Su M, Yao J, Yang Q, Chen J, Hu P, Liu H (2015) Body mass index is a marker of nutrition preparation sufficiency before surgery for Crohn's disease from the perspective of intra-abdominal septic complications: a retrospective cohort study. Medicine (Baltimore) 94(35):e1455CrossRefGoogle Scholar
  11. 11.
    Tzivanakis A, Singh JC, Guy RJ, Travis SPL, Mortensen NJ, George BD (2012) Influence of risk factors on the safety of ileocolic anastomosis in Crohn’s disease surgery. Dis Colon Rectum 55(5):558–562CrossRefPubMedGoogle Scholar
  12. 12.
    Alves A, Panis Y, Bouhnik Y, Pocard M, Vicaut E, Valleur P (2007) Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn’s disease: a multivariate analysis in 161 consecutive patients. Dis Colon Rectum 50(3):331–336CrossRefPubMedGoogle Scholar
  13. 13.
    Myrelid P, Olaison G, Sjodahl R et al (2009) Thiopurine therapy is associated with postoperative intra-abdominal septic complications in abdominal surgery for Crohn's disease. Dis Colon Rectum 52(8):1387–1394CrossRefPubMedGoogle Scholar
  14. 14.
    Yamamoto T, Allan RN, Keighley MR (2000) Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum 43(8):1141–1145CrossRefPubMedGoogle Scholar
  15. 15.
    Serradori T, Germain A, Scherrer ML, Ayav C, Perez M, Romain B, Palot JP, Rohr S, Peyrin-Biroulet L, Bresler L (2013) The effect of immune therapy on surgical site infection following Crohn’s disease resection. Br J Surg 100(8):1089–1093CrossRefPubMedGoogle Scholar
  16. 16.
    Riss S, Bittermann C, Zandl S, Kristo I, Stift A, Papay P, Vogelsang H, Mittlböck M, Herbst F (2010) Short-term complications of wide-lumen stapled anastomosis after ileocolic resection for Crohn’s disease: who is at risk? Color Dis 12(10 Online):e298–e303CrossRefGoogle Scholar
  17. 17.
    Yang SS, Yu CS, Yoon YS, Yoon SN, Lim SB, Kim JC (2012) Risk factors for complications after bowel surgery in Korean patients with Crohn's disease. J Korean Surg Soc 83(3):141–148CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ramsey S, Lamb GW, Aitchison M et al (2007) Evaluation of an inflammation-based prognostic score in patients with metastatic renal cancer. Cancer 109(2):205–212CrossRefPubMedGoogle Scholar
  19. 19.
    Mcmillan DC, Crozier JE, Canna K et al (2007) Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Color Dis 22(8):881–886CrossRefGoogle Scholar
  20. 20.
    Ishizuka M, Kita J, Shimoda M, Rokkaku K, Kato M, Sawada T, Kubota K (2009) Systemic inflammatory response predicts postoperative outcome in patients with liver metastases from colorectal cancer. J Surg Oncol 100(1):38–42CrossRefPubMedGoogle Scholar
  21. 21.
    Glen P, Jamieson NB, Mcmillan DC et al (2006) Evaluation of an inflammation-based prognostic score in patients with inoperable pancreatic cancer. Pancreatology 6(5):450–453CrossRefPubMedGoogle Scholar
  22. 22.
    Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN) (2003) ESPEN guidelines for nutrition. Screening 2002. Clin Nutr 22(4):415–421CrossRefPubMedGoogle Scholar
  23. 23.
    Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 55(6):749–753CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bruining DH, Siddiki HA, Fletcher JG, Tremaine WJ, Sandborn WJ, Loftus EV Jr (2008) Prevalence of penetrating disease and extraintestinal manifestations of Crohn’s disease detected with CT enterography. Inflamm Bowel Dis 14(12):1701–1706CrossRefPubMedGoogle Scholar
  25. 25.
    Li G, Ren J, Wang G, Hu D, Gu G, Liu S, Ren H, Wu X, Li J (2014) Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn’s disease. Eur J Clin Nutr 68(4):441–446CrossRefPubMedGoogle Scholar
  26. 26.
    Heerasing N, Thompson B, Hendy P, Heap GA, Walker G, Bethune R, Mansfield S, Calvert C, Kennedy NA, Ahmad T, Goodhand JR (2017) Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn’s disease. Aliment Pharmacol Ther 45(5):660–669CrossRefPubMedGoogle Scholar
  27. 27.
    Lee JS, Kim HJ, Cho HM, Lee KM, Kye BH (2016) The importance of the Crohn’s disease activity index in surgery for small bowel Crohn’s disease. J Visc Surg 153(5):339–345CrossRefPubMedGoogle Scholar
  28. 28.
    Guo Z, Guo D, Gong J, Zhu W, Zuo L, Sun J, Li N, Li J (2016) Preoperative nutritional therapy reduces the risk of anastomotic leakage in patients with Crohn’s disease requiring resections. Gastroenterol Res Pract 2016:5017856PubMedGoogle Scholar
  29. 29.
    Ishizuka M, Nagata H, Takagi K, Horie T, Kubota K (2007) Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer. Ann Surg 246(6):1047–1051CrossRefPubMedGoogle Scholar
  30. 30.
    Moyes LH, Leitch EF, Mckee RF et al (2009) Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer. Br J Cancer 100(8):1236–1239CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Kostner AH, Kersten C, Lowenmark T et al (2016) The prognostic role of systemic inflammation in patients undergoing resection of colorectal liver metastases: C-reactive protein (CRP) is a strong negative prognostic biomarker. J Surg Oncol 114(7):895–899CrossRefPubMedGoogle Scholar
  32. 32.
    Sugimoto K, Komiyama H, Kojima Y, Goto M, Tomiki Y, Sakamoto K (2012) Glasgow prognostic score as a prognostic factor in patients undergoing curative surgery for colorectal cancer. Dig Surg 29(6):503–509CrossRefPubMedGoogle Scholar
  33. 33.
    Solem CA, Loftus EJ, Tremaine WJ et al (2005) Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflamm Bowel Dis 11(8):707–712CrossRefPubMedGoogle Scholar
  34. 34.
    Koelewijn CL, Schwartz MP, Samsom M, Oldenburg B (2008) C-reactive protein levels during a relapse of Crohn’s disease are associated with the clinical course of the disease. World J Gastroenterol 14(1):85–89CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Simillis C, Yamamoto T, Reese GE, Umegae S, Matsumoto K, Darzi AW, Tekkis PP (2008) A meta-analysis comparing incidence of recurrence and indication for reoperation after surgery for perforating versus nonperforating Crohn’s disease. Am J Gastroenterol 103(1):196–205CrossRefPubMedGoogle Scholar
  36. 36.
    Bellolio F, Cohen Z, Macrae HM et al (2013) Outcomes following surgery for perforating Crohn’s disease. Br J Surg 100(10):1344–1348CrossRefPubMedGoogle Scholar
  37. 37.
    Nasir BS, Dozois EJ, Cima RR, Pemberton JH, Wolff BG, Sandborn WJ, Loftus EV, Larson DW (2010) Perioperative anti-tumor necrosis factor therapy does not increase the rate of early postoperative complications in Crohn's disease. J Gastrointest Surg 14(12):1859–1865 1865-1866CrossRefPubMedGoogle Scholar
  38. 38.
    Esaki M, Matsumoto T, Nakamura S, Yada S, Fujisawa K, Jo Y, Iida M (2006) Factors affecting recurrence in patients with Crohn’s disease under nutritional therapy. Dis Colon Rectum 49(10 Suppl):S68–S74CrossRefPubMedGoogle Scholar
  39. 39.
    Swoger JM, Regueiro M (2010) Preventive therapy in postoperative Crohn’s disease. Curr Opin Gastroenterol 26(4):337–343CrossRefPubMedGoogle Scholar
  40. 40.
    Nguyen GC, Elnahas A, Jackson TD (2014) The impact of preoperative steroid use on short-term outcomes following surgery for inflammatory bowel disease. J Crohns Colitis 8(12):1661–1667CrossRefPubMedGoogle Scholar
  41. 41.
    Colombel JF, Loftus EJ, Tremaine WJ et al (2004) Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 99(5):878–883CrossRefPubMedGoogle Scholar
  42. 42.
    Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L (2008) Perioperative treatment with infliximab in patients with Crohn’s disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg 12(10):1730–1736, 1736-1737CrossRefPubMedGoogle Scholar
  43. 43.
    Kasparek MS, Bruckmeier A, Beigel F, Müller MH, Brand S, Mansmann U, Jauch KW, Ochsenkühn T, Kreis ME (2012) Infliximab does not affect postoperative complication rates in Crohn’s patients undergoing abdominal surgery. Inflamm Bowel Dis 18(7):1207–1213CrossRefPubMedGoogle Scholar
  44. 44.
    Norgard BM, Nielsen J, Qvist N et al (2013) Pre-operative use of anti-TNF-alpha agents and the risk of post-operative complications in patients with Crohn's disease--a nationwide cohort study. Aliment Pharmacol Ther 37(2):214–224CrossRefPubMedGoogle Scholar
  45. 45.
    Syed A, Cross RK, Flasar MH (2013) Anti-tumor necrosis factor therapy is associated with infections after abdominal surgery in Crohn’s disease patients. Am J Gastroenterol 108(4):583–593CrossRefPubMedGoogle Scholar
  46. 46.
    Kopylov U, Ben-Horin S, Zmora O, Eliakim R, Katz LH (2012) Anti-tumor necrosis factor and postoperative complications in Crohn’s disease: systematic review and meta-analysis. Inflamm Bowel Dis 18(12):2404–2413CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yibin Zhu
    • 1
  • Haili Xu
    • 1
  • Wei Liu
    • 1
  • Weilin Qi
    • 1
  • Xiaoyan Yang
    • 1
  • Lingna Ye
    • 2
    • 3
  • Qian Cao
    • 2
    • 3
  • Wei Zhou
    • 1
    • 2
  1. 1.Department of General Surgery, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouPeople’s Republic of China
  2. 2.Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouPeople’s Republic of China
  3. 3.Department of Gastroenterology, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouPeople’s Republic of China

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