C-reactive protein can predict anastomotic leak in colorectal surgery: a systematic review and meta-analysis

Yeung, Denise; Peterknecht, Elizabeth; Hajibandeh, Shahab; Hajibandeh, Shahin; Torrance, Andrew W.

doi:10.1007/s00384-021-03854-5

Cited by 38 publications

(44 citation statements)

References 42 publications

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“…An association between postoperative complications and the early increase in IL-6 on the first postoperative day [ 38 ] and immediately after surgery [ 39 ] has been demonstrated, but the association has not been investigated for YKL-40. The relationship between postoperative systemic inflammation and major complications is expected, since many complications have an inflammatory component (e.g., anastomotic leak) and other studies have shown that high CRP on postoperative days three and four is associated with anastomotic leak [ 38 , 40 , 41 ]. Earlier detection of older frail patients at risk of major complications after resection for CRC is important, as delayed intervention might have fatal consequences for these patients.…”

Section: Discussionmentioning

confidence: 99%

Pre- and Perioperative Inflammatory Biomarkers in Older Patients Resected for Localized Colorectal Cancer: Associations with Complications and Prognosis

Dolin

Christensen

Johansen

et al. 2021

Cancers

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The association between pre- and perioperative inflammatory biomarkers, major complications, and survival rates after resection of colorectal cancer (CRC) in older patients is largely unknown. The aim was to investigate age-dependent differences in these associations. Serum CRP, IL-6, and YKL-40 were measured preoperatively and on the first and second day after resection of CRC (stages I–III) in 210 older (≥70 years) and 191 younger patients (<70 years). The results from the complications was presented as an odds ratio (OR, with a 95% confidence interval (CI)) with logistic regression. Results from the mortality rates were presented as a hazard ratio (HR, with a 95% CI) using Cox proportional hazards regression. The preoperative inflammatory biomarkers were higher in the older vs. the younger patients. The risk of complications was increased in older patients with a high preoperative CRP (OR = 1.25, 95% CI 1.03–1.53), IL-6 (OR = 1.57, 95% CI 1.18–2.08), and YKL-40 (OR = 1.66, 95% CI 1.20–2.28), but not in younger patients. Mortality was higher in younger patients with high preoperative YKL-40 (HR = 1.66, 95% CI 1.06–2.60). This was not found in older patients. Elevated preoperative inflammatory biomarkers among older patients were associated with an increased risk of complications, but not mortality. Preoperative inflammatory biomarkers may be useful in assessing the risk of a complicated surgical course in older patients with CRC.

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Section: Discussionmentioning

confidence: 99%

Pre- and Perioperative Inflammatory Biomarkers in Older Patients Resected for Localized Colorectal Cancer: Associations with Complications and Prognosis

Dolin

Christensen

Johansen

et al. 2021

Cancers

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“…Although anastomotic leakage was not observed in either group, the overall complication rate was lower in the endto-side group [14]. Previous studies have found that an elevated CRP level after colorectal surgery can be a predictor for anastomotic leakage [19][20][21]. The WBC count peaks 24-48 h after elective surgery, but the CRP level peaks later, at 24-72 h [22].…”

Section: Discussionmentioning

confidence: 78%

C-reactive protein level on postoperative day 3 as a predictor of anastomotic leakage after elective right-sided colectomy

et al. 2021

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Purpose To investigate the factors predictive of anastomotic leakage in patients undergoing elective right-sided colectomy. Methods The subjects of this retrospective study were 247 patients who underwent elective right hemicolectomy or ileocecal resection with ileocolic anastomosis between April 2012 and March 2019, at our institution. Results Anastomotic leakage occurred in 9 of the 247 patients (3.6%) and was diagnosed on median postoperative day (POD) 7 (range POD 3-12). There were no significant differences in the background factors or preoperative laboratory data between the patients with anastomotic leakage (anastomotic leakage group) and those without anastomotic leakage (no anastomotic leakage group). Open surgery was significantly more common than laparoscopic surgery (P = 0.027), and end-to-side anastomosis was less common (P = 0.025) in the anastomotic leakage group. The C-reactive protein (CRP) level in the anastomotic leakage group was higher than that in the no anastomotic leakage group on PODs 3 (P < 0.001) and 5 (P < 0.001). ROC curve analysis revealed that anastomotic leakage was significantly more frequent in patients with a serum CRP level ≥ 11.8 mg/dL [area under the curve (AUC) 0.83]. Conclusion A serum CRP level ≥ 11.8 mg/dL on POD 3 was predictive of anastomotic leakage being detected on median POD 7.

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“…A recent meta-analysis by Yeung et al summarized the results of 23 studies that assessed the use of postoperative CRP levels as a tool to predict ALs in colorectal surgery [21]. In a day-by-day comparison of the AL groups and the no-AL groups, CRP levels in Yeung's study were lower than in this one, a trend that was consistent from POD 1 to 5 (see Table 5).…”

Section: Discussionmentioning

confidence: 81%

Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients

Slavin

Goldstein

Raguan

et al. 2022

JPM

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Background: In colorectal cancer, C-reactive protein (CRP) levels on postoperative days 3–4 have a strong negative predictive value for an anastomotic leak, with threshold values of ~15 on post-operative day (POD) 3 and ~13 on POD 4. In Crohn’s disease, CRP levels are perceived as unreliable in the postoperative period because of the underlying inflammatory process. The aim of this study was to determine whether postoperative CRP levels can be used to rule out anastomotic leaks in patients with Crohn’s disease and to set CRP threshold values for this population. Methods: This was a retrospective study of a population of Crohn’s disease patients who underwent surgery with bowel anastomoses at a single high-volume center between 1/2012 and 12/2017. The operations were performed by a single colorectal consultant who is an inflammatory bowel disease specialist. Results: Ninety-two operations were performed. A CRP level of 19.56 mg/dL on postoperative day 3 had an area under the curve of 0.865 (sensitivity 88%, specificity 73%) and a negative predictive value (NPV) of 98% for an anastomotic leak. Patients with an anastomotic leak showed a trend towards decreased postoperative albumin levels (p = 0.06). Conclusions: Mean CRP levels and CRP threshold values were indeed higher in the study population compared with those in colorectal cancer patients. Threshold values were set at 20.3 mg/dL on POD 3, 19.5 mg/dL on POD 4 and 16.7 mg/dL on POD 5. These values had high NPVs and can be used to rule out anastomotic leaks in patients with Crohn’s disease after surgery with bowel anastomosis.

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C-reactive protein can predict anastomotic leak in colorectal surgery: a systematic review and meta-analysis

Cited by 38 publications

References 42 publications

Pre- and Perioperative Inflammatory Biomarkers in Older Patients Resected for Localized Colorectal Cancer: Associations with Complications and Prognosis

Pre- and Perioperative Inflammatory Biomarkers in Older Patients Resected for Localized Colorectal Cancer: Associations with Complications and Prognosis

C-reactive protein level on postoperative day 3 as a predictor of anastomotic leakage after elective right-sided colectomy

Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients

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