Diagnostic accuracy of procalcitonin for the early diagnosis of anastomotic leakage after colorectal surgery: a meta‐analysis

Abstract

Background: Anastomotic leakage (AL) is a dreaded complication following colorectal surgery. Procalcitonin is one of many biomarkers studied and research has suggested that it has improved accuracy for the diagnosis of AL compared with other inflammatory biomarkers such as C-reactive protein. This meta-analysis was conducted to evaluate the accuracy of procalcitonin in the early diagnosis of AL following colorectal surgery. Methods: MEDLINE, Embase and PubMed were searched for studies evaluating procalcitonin in the context of AL following colorectal surgery in the elective setting. The literature was reviewed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Quality of the studies was assessed using the Quality Assessment Diagnostic Accuracy Studies (QUADAS)-2 tool. Meta analyses were conducted using area under the receiver operating characteristic curves for day 3, 4 and 5 post-surgery as a diagnostic test to detect AL. Results: A total of eight studies were analysed. Results showed that the highest diagnostic accuracy for procalcitonin is on day 5 post surgery. The reported optimal cut-off values ranged from 0.25 to 680 ng/mL from postoperative day 3 to 5, with reported negative predictive values ranging from 95% to 100%, and positive predictive values of up to 34%. The highest area under the receiver operating characteristic curve was 0.88 on postoperative day 5. Conclusion: Procalcitonin is a useful negative test for AL following elective colorectal surgery. However, as an isolated test, it is not useful in detecting AL.© 2019 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 675-680ANZJSurg.com

Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study

“…However, it remained steadily increased in G3 patients, with a markedly high mean value from POD1 to POD5. Yeung et al [ 43 ] performed the most comprehensive meta-analysis available in the literature, including nearly 7000 patients pooled from 23 studies. From POD1 to POD7, patients with CAL had a significantly higher mean CRP level compared with patients without CAL ( P < 0.001)[ 43 ].…”

“…Yeung et al [ 43 ] performed the most comprehensive meta-analysis available in the literature, including nearly 7000 patients pooled from 23 studies. From POD1 to POD7, patients with CAL had a significantly higher mean CRP level compared with patients without CAL ( P < 0.001)[ 43 ]. In this study, CRP was the best predictor for CAL on POD4 and POD5, with a maximum AUROC of 0.81 (cut-off value of 96.8 mg/L and an NPV of 98%) on POD5.…”

“…In the Italian ColoRectal Anastomotic Leakage (iCral) multicentric prospective observational study, the CRP level was a good positive and excellent negative predictor of CAL, with an AUROC of 0.81 on POD6 (cut-off value of 81.5 mg/L), and an SS and NPV of 80.9% and 97.7%, respectively[ 41 ]. In the meta-analysis by Yeung et al [ 43 ], AUROC analysis established a threshold CRP level for CAL of 115 mg/L on POD5, with an SS and SP of 100%. All of these authors recommended CRP levels to predict CAL, and our group advocates a similar practice and suggests the use of this biomarker to expedite further investigation and treatment[ 25 , 26 , 41 , 43 ].…”

“…In the meta-analysis by Yeung et al [ 43 ], AUROC analysis established a threshold CRP level for CAL of 115 mg/L on POD5, with an SS and SP of 100%. All of these authors recommended CRP levels to predict CAL, and our group advocates a similar practice and suggests the use of this biomarker to expedite further investigation and treatment[ 25 , 26 , 41 , 43 ].…”

Serum markers for the early diagnosis of intestinal anastomotic leak after gyne-oncological operations

“…Also, in a recent meta-analysis, it was concluded that PCT is a useful negative test for AL after elective colorectal surgery with negative predictive values ranging from 95% to 100% (highest AUROC was 0.88 on POD 5). But, as an isolated test, poor positive predictive values of up to 34%, limit its use in predicting AL 8 . Different from elective colorectal surgeries, in the surgical concept of gynecological malignancies (especially in advanced ovarian cancer), debulking procedures including both upper and lower abdomen and peritonectomy were needed to reach zero macroscopic residual disease to get overall survival advantage 9,10 .…”