Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage

Abstract

BACKGROUND: We aim to determine if C-reactive protein (CRP), lipopolysaccharide-binding protein (LBP), and procalcitonin (PCT) in drain fluid can serve as screening tools for colorectal anastomotic leakage (CAL).METHODS: Patients included in this multicenter prospective observational study underwent left hemicolectomy, sigmoid resection, high anterior resection, low anterior resection, or subtotal colectomy. During the first 5 postoperative days, CRP, LBP, and PCT were determined on drain fluid. RESULTS: In total 243 patients were included, of whom 19 (8%) developed CAL. CRP levels were higher in patients with leakage on day 3 and day 5, levels of LBP were higher on days 2, 3, and 4, and PCT levels were higher on day 5. Multivariate analysis showed LBP to be significantly related to CAL. An increase in the average initial value at the first postoperative day with 1 standard deviation increased the risk of leakage by 1.6 times.This research was made possible by grant from ''Stichting Technische Wetenschappen'' (STW), Utrecht, The Netherlands. STW had no role in the study design, in collection, analysis and interpretation of the data, in writing of this manuscript or in the decision to submit.

The value of biomarkers in early diagnosis of anastomotic leak following colorectal tumor resection: a review of the literature between 2012 and 2017

“…Similar conclusions had been got in other researches [7,10,14,18]. There are also studies to determine whether PCT in drain fluid can serve as screening tool for AL [19]. Unfortunately, the results showed that examination of PCT in drain fluid could not help to detect AL.…”

“…The details were summarized in Table 1, Table 2, and Table 3. There are also studies to determine whether CRP in drain fluid can serve as screening tool for AL [18,19]. However, the results showed that examination CRP in drain fluid could not help to detect AL.…”

“…Besides, there were also researchers aimed to determine if lipopolysaccharide-binding protein (LBP) can serve as screening tool for colorectal AL. They got that increased concentrations of LBP in drain fluid are significantly associated to a higher chance of AL and could contribute in a future prognostic model for AL [19]. Peritoneal biomarkers for detecting AL is very promising and worth further attempt.…”

“…A cut-off value of 6.978 determined at 25°C on POD3 maximizes the sensitivity and specificity [26]. Evidences showed that carcinoembryonic antigen (CEA) elevation were associated with the inflammation process that accompanies AL [19]. So the idea that measuring CEA of drain as an indicator of AL was put forward.…”

“…a daily rise of around 50 units being most predictive Burke, 2017, [17] CRP (POD5, cutoff value:132 mg/l), CRP (sensitivity 70%, specilficity 76.6%), Ismail, 2017, [18] Serum CRP and PCT (POD3), Drain TNF-a and bacterial proliferation (POD5) Komen, 2014, [19] LBP An increase in the average initial value at the first postoperative day with 1 standard deviation increased the risk of leakage by 1.6 times. Urszula, 2016, [21] PCT (POD1, cutoff value:1.09 ng/mL) Sensitivity 87%, specilficity 87% Tarik, 2016, [22] Peritoneal IL-6 (POD1, cutoff value:3091 pg/ml); peritoneal IL-10 (POD1, cutoff value:504 pg/ml) Peritoneal IL-6 (sensitivity 86%, specilficity 52%), peritoneal IL-10 (sensitivity 86%, specilficity 62%) Elyamani, 2011, [23] Cytokines (IL-6, IL-10, TNF), microbiological study (Escherichia coli, Klebsiella, Pseudomonas species, and bacteriod microorganism) Käser, 2014, [25] Hyponatremia Sensitivity 23%, specilficity 93% Liu, 2013, [26] PH: POD3, cutoff value: 6.978 Sensitivity 98.7%, specilficity 94.7% Liron, 2016, [27] CEA (1000 ng/mL) drainage fluid after rectal surgery with anastomosis, is a marker of AL.…”