CONCENTRATION OF SERUM C-REACTIVE PROTEIN (CRP) IN DOGS WITH COMPLICATIONS IN WOUND HEALING

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CONCENTRATION OF SERUM C-REACTIVE PROTEIN (CRP) IN DOGS WITH COMPLICATIONS IN WOUND HEALING

Knapp A¹, Schrödl W², Grevel Vera1, Oechtering G¹
¹ Small Animal Clinic, Faculty of Veterinary Medicine, University of Leipzig An den Tierkliniken 23, 04103 Leipzig (Germany).
e-mail: aknapp1168@aol.com
² Institute for Bacteriology und Mycology, Faculty of Veterinary Medicine, University of Leipzig

INTRODUCTION: The diagnostic of complications in wound healing is an important part in the management of wounds. The development of wound infections - one of the most common complication - depends very much on the time of its recognition. The clinical based diagnosis of wound infection is difficult and the interpretation of clinical signs very subjective. In human medicine the concentration of the serum C-reactive Protein (CRP) is known as an useful parameter for the assessment of the wound healing situation in addition to clinical findings. The main purpose of this study was to quantify the serum CRP levels in dogs with complications in wound healing after surgery in comparison to clinical symptoms, body temperature and white blood cell count.

MATERIALS AND METHODS: To establish the reference value of the concentration of CRP sera from 39 clinical healthy dogs were tested by ELISA. 175 dogs subjected to surgery were studied prospectively. From these dogs 66 were excluded because they stayed no longer than three days after surgery, five because they showed signs of infection prior to surgery and five for the reason of non-surgical complications. 99 dogs were evaluated before and 5 days post operatively. The control group consisted of dogs without complications in wound healing. Dogs which developed complications were put together in groups such as wound infection, wound dehiscence, seroma, haematoma and prolonged inflammatory conditions.

RESULTS: The reference value of the serum CRP concentration has shown to be x (median) = 13.5 µg/ml (25 % quartil: 9.9 µg/ml, 75 % quartile: 20,5 µg/ml). After surgery 57 dogs had no complications in wound healing. In these patients the CRP increased from 57.2 µg/ml (x) prior surgery to 170.0 µg/ml (x) at the first day after surgery. CRP steadily decreased during the following five days to 30.1 µg/ml (x) at day six. Dogs which developed a wound infection (n = 11) showed an increase in CRP to 211.0 µg/ml (x) at the first day. But there was no further decrease after the third day and the CRP levels at day two (x = 196.8 µg/ml), three (x = 125.0 µg/ml), four (x = 120.5 µg/ml), five (x = 157.5 µg/ml) and six (x = 114.9 µg/ml) were higher than the values of the control group. In six out of eleven dogs the decrease of the CRP concentration after the first peak was followed by a second peak. In one patient the second peak took place before and in four dogs at the time of the clinical manifestation of the wound infection. In five dogs which showed no second peak the CRP values on day six were 6- to 24-fold (x = 329.1 µg/ml) above the reference value. The behaviour of the CRP in dogs with wound dehiscence (n = 5) or prolonged inflammatory condition (n = 12) was very similar to those with wound infection. In contrast dogs with seroma (n = 6) or haematoma (n = 7) showed no great difference in comparison to the control group. In all groups body temperature and white blood cell count showed no characteristic behaviour during wound healing.

CONCLUSION: The first peak of CRP and its steady decrease in dogs without complications represents the surgical trauma and the normal wound healing process. The higher levels of CRP in dogs with wound infection on the days two to six in comparison to the control group seems to be a systemic response to the local infection with marked inflammatory processes. In contrast to similar studies in human medicine only one patient with wound infection showed an early second increase in CRP before clinical manifestation. At this point an early detection of infectious conditions through measurement of the CRP seems to be impossible. But the similarity between the behaviour of the CRP in dogs with wound infection and in dogs with prolonged inflammatory condition is a strong hint, that these marked and prolonged inflammatory processes are based on infectious conditions. These infectious conditions may not appear clinically (e.g. purulent discharge) in dogs with prolonged inflammatory processes because the animal has shown to be able to manage this infection by himself. Based on the results of this study there is a high probability that - in contrast to the commonly accepted evidences for the diagnosis of wound infection - constantly high or again rising concentrations of CRP in combination with prolonged local inflammatory conditions proof the presence of wound infection. Based on the same conclusion the similar behaviour of CRP in dogs with wound dehiscence seems to be an hint of an underlying infectious process. CRP has shown to be an useful parameter for the objective assessment of local inflammatory or infectious conditions and a good supplementation to clinical findings.

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