Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program

Muñoz, José Luis; Alvarez, María Oliva; Cuquerella, Vicent; Miranda, Elena; Picó, Carlos del Pozo; Flores, Raquel; Resalt-Pereira, Marta; Moya, Pedro; Pérez, Antonio Solanas; Arroyo, Antonio

doi:10.1007/s00464-018-6144-x

Cited by 60 publications

(62 citation statements)

References 33 publications

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“…In another study, Muñoz et al evaluated only patients who underwent elective laparoscopic colorectal cancer resection using the enhanced recovery after surgery (ERAS) protocol. In their study, CRP had a high NPV on POD 3 with a cutoff level of 163 mg/L 33 .…”

Section: Discussionmentioning

confidence: 85%

“…Nonetheless, most studies support the notion that patients with anastomotic leakage present higher and sustained elevation of serum CRP levels in the postoperative period compared with patients without leakage 33,34,36,39,42 . According to several studies, increased serum CRP levels precede radiologic and clinical diagnosis of anastomotic leakage.…”

Section: Discussionmentioning

confidence: 96%

“…Because vital signs and leukocyte numbers are slow in responding, it is important to identify tools to detect early leakage 36,37 . Early diagnosis is essential to reduce morbidity and mortality 33,[38][39][40] because delayed diagnosis can increase mortality by 18% 37 .…”

Section: Discussionmentioning

confidence: 99%

“…Patients tend to be discharged early, between PODs 4 and 5, with the advent of multimodal accelerated postoperative recovery protocols such as ERAS 33,35,41 . Because most surgical complications occur after patients are discharged, between PODs 5 and 8, a marker such as CRP, which has a high NPV on POD 4, could be used to exclude anastomotic leakage and other postoperative complications 38 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition to being used for the diagnosis of anastomotic leakage, CRP is also used as a marker of severity in gastrointestinal pathologies and infectious complications of open and laparoscopic surgeries 26,[28][29][30][31][32][33] . The objective of this study was to determine whether serum CRP levels of patients who had undergone emergency or elective colorectal surgery with primary anastomosis can be used to exclude the presence of anastomotic leakage and allow for safe and early discharge.…”

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confidence: 99%

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Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery

Messias¹,

Botelho

Saad

et al. 2020

Sci Rep

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Anastomotic leakage is a complication of colorectal surgery. c-reactive protein (cRp) is an acutephase marker that can indicate surgical complications. We determined whether serum cRp levels in patients who had undergone colorectal surgery can be used to exclude the presence of anastomotic leakage and allow safe early discharge. We included 90 patients who underwent colorectal surgery with primary anastomosis. Serum cRp levels were measured retrospectively on postoperative days (poDs) 1-7. Patients with anastomotic leakage (n = 11) were compared to those without leakage (n = 79). We statistically analysed data and plotted receiver operating characteristic curves. the incidence of anastomotic leakage was 12.2%. Diagnoses were made on PODs 3-24. The overall mortality rate was 3.3% (18.2% in the leakage group, 1.3% in the non-leakage group; P < 0.045). CRP levels were most accurate on POD 4, with a cutoff level of 180 mg/L, showing an area under the curve of 0.821 and a negative predictive value of 97.2%. Lower CRP levels after POD 2 and levels <180 mg/L on POD 4 may indicate the absence of anastomotic leakage and may allow safe discharge of patients who had undergone colorectal surgery with primary anastomosis.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery

Messias¹,

Botelho

Saad

et al. 2020

Sci Rep

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Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single‐center prospective cohort study

Tan

Liu

et al. 2023

Cancer Reports

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Background Anastomotic leakage (AL) is one of the common complications after rectal cancer surgery. This study aimed to evaluate the combination of biomarkers for the early prediction of symptomatic AL after surgery. Methods A prospective cohort study evaluated the serum and peritoneal biomarkers of patients who underwent laparoscopic low anterior resection (Lap LAR) from November 1, 2021, to May 1, 2022. Multivariate‐penalized logistic regression was performed to explore the independent biomarker with a P‐value <.1, and receiver operating characteristic (ROC) curve was used to analyze the area under the curve (AUC), sensitivity, and specificity of the independent biomarkers. A predictive model for symptomatic AL was built based on the independent biomarkers and was visualized with a nomogram. The calibration curve with the concordance index (c‐index) was further applied to evaluate the efficacy of the predictive model. Results A total of 157 patients were included in this study, and 7 (4.5%) were diagnosed with symptomatic AL. C‐reactive protein/album ratio (CAR) on postoperative day 1 and systemic immune‐inflammation index (SII) and peritoneal interleukin‐6 (IL‐6) on postoperative day 3 were proven to be independent predictors for the early prediction of symptomatic AL. The optimal cutoff values of CAR, SII, and peritoneal IL‐6 were 1.04, 916.99, and 26430.09 pg/ml, respectively. Finally, the nomogram, including these predictors, was established, and the c‐index of this nomogram was 0.812, indicating that the nomogram could be used for potential clinical reference. Conclusion The combination of CAR, SII, and peritoneal IL‐6 might contribute to the early prediction of symptomatic AL in patients following Lap LAR. Given the limitations of this study and the emergence of other novel biomarkers, multicenter prospective studies are worthy of further exploration.

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Serum procalcitonin as an early diagnostic marker of severe postoperative complications after elective pancreaticoduodenectomy

Hata

Mizuma

Motoi

et al. 2020

J Hepato Biliary Pancreat

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Background/Purpose: To evaluate the clinical utility of serum procalcitonin (PCT) as a diagnostic marker for the severe postoperative complications associated with pancreaticoduodenectomy (PD). Methods: A total of 387 patients were enrolled and the PCT and C-reactive protein (CRP) values were compared between the non-severe complications group (Clavien-Dindo classification Grade IIIb and lower) and severe complications (Grade IVa and higher). Results: Severe complications occurred in 16 patients. In the severe complications group, CRP levels peaked on postoperative day (POD) 3, whereas PCT levels peaked on POD 1. The PCT levels on PODs 1-5 were significantly higher in the severe complications group. Regarding the diagnostic performance, the PCT value on POD 2 higher than 2.1 ng/mL revealed the highest performance, with 66.7% sensitivity and 78.6% specificity. Based on the postoperative kinetics and multivariate analysis, PCT and CRP both act independently of each other and the combination assay improved the diagnostic power (area under the curve 0.781; sensitivity 60.0%; specificity 85.6%). Preoperative biliary drainage was found to affect the perioperative PCT values and subgroup analysis stratified by the drainage procedure improved diagnostic sensitivity (~85%). Conclusions: Procalcitonin in the early postoperative period can serve as an earlier detector for the development of severe complications after PD.

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Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program

Abstract: CRP and PCT are relevant markers for detecting postoperative AL after laparoscopic colorectal surgery. Furthermore, they can ensure an early discharge with a low probability of AL when an ERAS program is performed.

Cited by 60 publications

References 33 publications

Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery

Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery

Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single‐center prospective cohort study

Serum procalcitonin as an early diagnostic marker of severe postoperative complications after elective pancreaticoduodenectomy

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