Diagnostic accuracy of C‐reactive protein, procalcitonin and neutrophils for the early detection of anastomotic leakage after colorectal resection: a multicentric, prospective study

Abstract

Aim The aim was to determine the accuracy of C‐reactive protein (CRP), procalcitonin and neutrophils in the early detection (fourth postoperative day) of anastomotic leakage (AL) after colorectal surgery. Methods We conducted a multicentre, prospective study that included a consecutive series of patients who underwent colorectal resection with anastomosis without ostomy (September 2015 to December 2017). CRP, procalcitonin and neutrophil values on the fourth postoperative day after colorectal resection along with the postoperative outcome (60‐day AL, morbidity and mortality) were prospectively included in an online, anonymous database. Results The analysis ultimately included 2501 cases. The overall morbidity and mortality was 30.1% and 1.6%, respectively, and the AL rate was 8.6%. The area under the receiver operating characteristic curve values (95% CI) for detecting AL were 0.84 (0.81–0.87), 0.75 (0.72–0.79) and 0.70 (0.66–0.74) for CRP, procalcitonin and neutrophils, respectively. The best cut‐off level for CRP was 119 mg/l, resulting in 70% sensitivity, 81% specificity and 97% negative predictive value. After laparoscopic resection, the accuracy for CRP and procalcitonin was increased, compared with open resection. The combination of two or three of these biomarkers did not significantly increase their accuracy. Conclusion On the fourth postoperative day, CRP was the most reliable marker for excluding AL. Its high negative predictive value, especially after laparoscopic resection, allows for safe hospital discharge on the fourth postoperative day. The routine use of procalcitonin or neutrophil counts does not seem to increase the diagnostic accuracy.

Early Predictors of Fistula Formation Following Head and Neck Reconstruction

“…9 Recently, CRP has been widely reported as an early predictor of postoperative complications, such as anastomotic leakage, after colorectal surgery. [11][12][13][14][15][16][17] Sala et al conducted a multicenter prospective study involving 2,501 cases undergoing colorectal surgery and concluded that CRP is a reliable marker for detecting leakage, with a cutoff level of 11.9 mg/dL on POD 4, a sensitivity of 70%, a specificity of 81%, and an NPV of 97%. 11 Yeung et al conducted a systematic review involving 6,647 cases undergoing colorectal surgery and found a significant difference in the CRP values on POD 1 to POD 7 between the leaked and nonleak groups, particularly on POD 4 to POD 7, with a specificity of 100%.…”

“…[11][12][13][14][15][16][17] Sala et al conducted a multicenter prospective study involving 2,501 cases undergoing colorectal surgery and concluded that CRP is a reliable marker for detecting leakage, with a cutoff level of 11.9 mg/dL on POD 4, a sensitivity of 70%, a specificity of 81%, and an NPV of 97%. 11 Yeung et al conducted a systematic review involving 6,647 cases undergoing colorectal surgery and found a significant difference in the CRP values on POD 1 to POD 7 between the leaked and nonleak groups, particularly on POD 4 to POD 7, with a specificity of 100%. 12 Although these reports were in the field of colorectal surgery, oropharyngeal surgery is classified as class II/clean-contaminated operative wound according to the Centers for Disease Control and Prevention criteria similar to colorectal surgery; therefore, CRP can be applied as a predictor of postoperative leakage.…”

“…[11][12][13][14][15][16][17] Sala et al conducted a multicenter prospective study involving 2,501 cases undergoing colorectal surgery and…”

Risk Factors and Preventive Measures for Anastomotic Leak in Colorectal Cancer

“…29 A multicenter prospective study showed that the detection of CRP on the fourth postoperative day of CRC could improve the accuracy of AL diagnosis compared to PCT or neutrophil count, and a high negative predictive value of CRP could guide the safe discharge time of patients. 30 In addition, combined detection of CRP trajectory and cut-off points may be also valuable in accurate diagnosis of AL. 31 Apart from detecting blood inflammation indicators, a recent study suggested that high bacteriological concentration in drainage fluid was a reliable indicator for the prediction and diagnosis of AL.…”

Diverting Stoma Prevents Symptomatic Anastomotic Leakage but Not Intra-abdominal Infection After Low Anterior Resection

“…Several independent factors have been identi ed, including distance of the tumor from anal verge, age, male gender and obesity [5][6][7]. Moreover, many recent studies have proposed in ammatory markers as early predictors of leakage-related infection [8][9][10]. Unfortunately, retrospective and observational studies are greatly limited by nonstandard data records.…”