C‐reactive protein as a predictor of anastomotic leak in the first week after anterior resection for rectal cancer

Abstract

Aim Anastomotic leak (AL) after anterior resection results in increased morbidity, mortality and local recurrence. The aim of this study was to assess the ability of C-reactive protein (CRP) to predict AL in the first week after anterior resection for rectal cancer.Method A retrospective review of a prospectively maintained database that included all patients undergoing anterior resection between January 2008 and December 2013 was performed. The ability of CRP to predict AL was assessed using area under the receiver-operating characteristics (AUC) curves. The severity of AL was defined using the International Study Group of Rectal Cancer (ISREC) grading system.Results Two-hundred and eleven patients were included in the study. Statistically significant differences in mean CRP values were found between those with and without an AL on postoperative days 5, 6 and 7. A CRP value of 132 mg/l on postoperative day 5 had an AUC of 0.75, corresponding to a sensitivity of 70%, a specificity of 76.6%, a positive predictive value of 16.3% and a negative predictive value of 97.5%. Multivariable analysis found that a CRP of > 132 mg/l on postoperative day 5 was the only statistically significant patient factor that was linked to an increased risk of AL (HR = 8.023, 95% CI: 1.936-33.238, P = 0.004).Conclusion Early detection of AL may minimize postoperative complications. CRP is a useful negative predictive test for the development of AL following anterior resection.

Systematic use of the serum C‐reactive protein concentration and computed tomography for the detection of intestinal anastomotic leaks

“…The serum CRP concentration is commonly used as a surrogate marker for infection, and evidence suggests that it can be used to detect or to rule out colorectal anastomotic leak as a post‐operative complication . Multiple research articles focused on the determination of a cut‐off value for CRP . Some authors advocated CRP as a parameter to facilitate patient discharge .…”

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

“…The cut-off value of 140 mg/L on POD3 maximized the sensitivity (78%) and specificity (86%) of serum CRP in assessing the risk of leakage [6]. Serum CRP has been evaluated in other 11 studies [7][8][9][10][11][12][13][14][15][16][17]. In general, the CRP level was raised significantly days before the diagnosis of AL.…”

“…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.…”

Shift in paradigm of clinical management of anastomotic leak?

“…We read, with great interest, the article titled ‘C‐reactive protein as a predictor of anastomotic leak in the first week after anterior resection for rectal cancer’ by Reynolds et al . . The authors analysed the ability of C‐reactive protein (CRP) to predict anastomotic leak (AL) in the first week after anterior resection for rectal cancer.…”