ORIGINAL ARTICLE E. GuÈnel á O. CË agÆlayan á F. CË agÆlayan á T. K. Sahin Acute-phase changes in children recovering from minor surgery Accepted: 17 June 1998 Abstract The metabolic response to surgical stress is a nonspeci®c increase in hepatic synthesis of some spe- cialized acute-phase proteins and a decrease in plasma concentrations of visceral proteins following surgical trauma. This study was undertaken determine which speci®c proteins were the better clinical indices in mon- itoring the metabolic response to surgical stress in chil- dren recovering from minor surgery. Forty-four patients undergoing elective inguinal surgical procedures under general anesthesia were studied. Blood samples were collected preoperatively ()1) and at 1(+1) and 5(+5) days postoperatively to determine albumin (AL), Pre- albumin (PA), C-reactive protein (CRP), and a 1 -acid glycoprotein (AGP) values, and to calculate the prog- nostic in¯ammatory and nutritional index (PINI). Mean AL values were the same on all days. Mean PA +1 was signi®cantly lower than PA )1 and PA +5 (P < 0.001). Median CRP +1 and mean AGP +1 values were sig- ni®cantly higher than median CRP )1 and mean AGP )1(P < 0.0001), respectively. Although there was a decrease after postoperative day 1, median CRP +5 and mean AGP +5 values were still signi®cantly higher than preoperative values (P < 0.01 and P < 0.0001). Moreover, the median PINI +1 was also greater than PINI )1 and PINI +5 (P < 0.0001), but the median PINI+5 was signi®cantly higher than PINI )1 (P < 0.01). Median percent changes of PINI values were signi®cantly higher than those of the other pa- rameters from both preoperatively to postoperative day 1 and preoperatively to postoperative day 5. Although several speci®c proteins (AL, PA, CRP, and AGP) have been evaluated as indicators of the acute metabolic re- sponse, we suggest that the PINI is more valuable for re¯ecting the response to surgical stress in patients re- covering from minor surgery. Key words Surgical stress á Visceral protein á Acute- phase protein á Childhood Introduction The metabolic response to surgical stress is a nonspeci®c increase in the hepatic synthesis of some specialized proteins. These proteins, such as C-reactive pro- tein (CRP) and a 1 -acid glycoprotein (AGP), are known as acute-phase proteins, and also appear in response to a variety of stimuli such as tissue injury, in¯ammation, bacterial infection, antigen-antibody interactions, and endotoxin challenge [3, 11]. On the other hand, albumin (AL) and prealbumin (PA) are visceral proteins; that is, their serum concentrations decrease after trauma, sur- gery, or stress [3, 6, 7, 9]. These serum proteins have traditionally been used for assessment of nutritional status, and are considered to re¯ect visceral protein stores [1]. But they may also re- ¯ect the severity of the metabolic response to surgical stress and the prognosis in critically ill patients [2]. In many clinical situations, it may be dicult to determine whether changes in a patient's serum protein levels re¯ect nutritional status or a metabolic response to surgical trauma. This study was undertaken to determine which proteins are better clinical indices in monitoring only the metabolic response to surgical trauma in children re- covering from minor surgery in the outpatient setting. Patients and methods Forty-four patients (37 boys, 7 girls) undergoing elective surgical procedures under general anesthesia were studied in the Depart- ment of Pediatric Surgery, Medical School of SelcËuk University. The mean age was 7.34  4.1 years (7 months to 15 years) and the diagnoses were inguinal hernia (34), undescended testis (7), and Pediatr Surg Int (1998) 14: 199±201 Ó Springer-Verlag 1998 E. GuÈnel (&) 1 á O. CË agÆlayan á F. CË agÆlayan á T.K. Sahin Departments of Pediatric Surgery, Biochemistry and Public Health, SelcËuk University, School of Medicine, Konya, Turkey Corresponding address: 1 Babalk mah. Vatan cad. Kartal Sitesi No: 12/5, 42040 Konya, Turkey