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

Abstract

Background This study aimed to characterize the time‐dependent relationship between serum C‐reactive protein (CRP) and anastomotic integrity in the early post‐operative period and to develop a systematic use of CRP and computed tomography. Methods Patients aged 18 years or over who had the formation of a left‐sided colonic or a colorectal anastomosis, in Royal Sussex County Hospital, were included. The post‐operative day (POD) CRP cut‐off values were calculated according to receiver operating characteristic analysis to evaluate the sensitivities and specificities of the proposed cut‐off parameters. Results A total of 125 left‐sided colonic and colorectal anastomoses were recruited and analysed. When comparing to POD1 CRP cut‐off, the calculated CRP ratio cut‐off values of all the rest of PODs (2–5) were highly significant in the laparoscopic group and the overall group (P < 0.001). This statistically significant ratio was also demonstrated in the open group at POD2 (P < 0.0001). Conclusion CRP and CRP ratios cut‐off values were sensitive to detect an anastomotic leak in the early post‐operative period. The cut‐off values could facilitate the development of systematic use of CRP and computed tomography.

Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients

“…CRP levels, in line with other studies, measured on the 4th day provided the highest diagnostic accuracy for identifying postoperative complications, whereas WBCC contributed little information [174]. These results were supported by other retrospective [176] and prospective studies [170]. A further study demonstrated that in patients who developed an AL, increased WBCC only occurred after 6 days following surgery [165].…”

“…In contrast to these results, recent research has shown that serum CRP levels can become elevated several days before clinical AL diagnosis and are significantly raised in comparison to patients who have an uneventful post-operative recovery [165][166][167][168][169][170][171][172][173][174][175][176][177]. Currently, the main issue with using serum CRP levels for AL prediction or diagnosis is the lack of definitive cut-off values.…”

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

“…Several studies have reported serum CRP as an early predictor of AL after colorectal surgery. 7 , 14 , 15 A recent prospective multicenter study involving 833 patients further demonstrated that a change in CRP level of more than 50 mg/L between any 2 consecutive days after surgery had a sensitivity of 85% in predicting AL. 16 However, the use of CRP in early AL diagnosis remains controversial, with two main limitations.…”

Oxidative Stress Level as a Predictor of Anastomotic Leakage after Rectal Surgery

“…At present, the most widely studied biomarker for prediction of AL is CRP [13,14,[24][25][26][27][28][29][30][31][32][33][34][35][36][37]. NEUT and WBC counts are also candidate indicators; however, their value in prediction of AL is still controversial [38].…”