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

Abstract

BACKGROUND Colorectal anastomotic leakage (CAL) is one of the most dreaded complications after colorectal surgery, with an incidence that can be as high as 27%. This event is associated with increased morbidity and mortality; therefore, its early diagnosis is crucial to reduce clinical consequences and costs. Some biomarkers have been suggested as laboratory tools for the diagnosis of CAL. AIM To assess the usefulness of plasma C-reactive protein (CRP) and calprotectin (CLP) as early predictors of CAL. METHODS A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis, from March 2017 to August 2019. Patients were divided into three groups: G1 – no complications; G2 – complications not related to CAL; and G3 – CAL. Five biomarkers were measured and analyzed in the first 5 postoperative days (PODs), namely white blood cell (WBC) count, eosinophil cell count (ECC), CRP, CLP, and procalcitonin (PCT). Clinical criteria, such as abdominal pain and clinical condition, were also assessed. The correlation between biomarkers and CAL was evaluated. Receiver operating characteristic (ROC) curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL, and the area under the ROC curve (AUROC), specificity, sensitivity, positive predictive value, and negative predictive value (NPV) during this period were estimated. RESULTS In total, 25 of 396 patients developed CAL (6.3%), and the mean time for this diagnosis was 9.0 ± 6.8 d. Some operative characteristics, such as surgical approach, blood loss, intraoperative complications, and duration of the procedure, were notably related to the development of CAL. The length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications (median of 21 d vs 13 d and 7 d respectively; P < 0.001). For abdominal pain, the best predictive performance was on POD4 and POD5, with the largest AUROC of 0.84 on POD4. Worsening of the clinical condition was associated with the diagnosis of CAL, presenting a higher predictive effect on POD5, with an AUROC of 0.9. WBC and ECC showed better predictive effects on POD5 (AUROC = 0.62 and 0.7, respectively). Those markers also presented a high NPV (94%-98%). PCT had the best predictive effect on POD5 (AUROC = 0.61), although it presented low accuracy. However, this biomarker revealed a high NPV on POD3, POD4, and POD5 (96%, 95%, and 96%, respectively). The mean CRP value on POD5 was significantly higher in the group that developed CAL compared with the group without complications (195.5 ± 139.9 mg/L vs 59.5 ± 43.4 mg/L; P < 0.00001). On POD5, CRP had a NPV of 98%. The mean CLP value on POD3 was significantly higher in G3 compared with G1 (5.26 ± 3.58 μg...

Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope?

“…The study included patients undergoing urgent or elective colorectal resection, regardless of the approach (open or laparoscopic), indication (benign or malignant), and creation of a protective stoma. Data was collected between March 1, 2017 and August 31, 2019 and recorded in a database according to the study protocol previously published[ 17 ]. CAL, the main endpoint, was defined in accordance with clinical, imaging, and surgical criteria[ 5 , 17 , 18 ].…”

“…Data was collected between March 1, 2017 and August 31, 2019 and recorded in a database according to the study protocol previously published[ 17 ]. CAL, the main endpoint, was defined in accordance with clinical, imaging, and surgical criteria[ 5 , 17 , 18 ]. Patients were excluded from the study if under 18-years-old, pregnant, unable to give written informed consent, had not received R0 resection with anastomosis, or had inflammatory bowel disease.…”

Using preoperative C‐reactive protein levels to predict anastomotic leaks and other complications after elective colorectal surgery: A systematic review and meta‐analysis

“…There is established evidence, through multiple meta-analyses, that a high CRP level on postoperative days (PODs) 3-5 is a highly sensitive test for AL, with cut-off values ranging from 120 to 170 mg/L being associated with negative predictive values of 97% [2,[21][22][23]. Diagnostic accuracy may be further increased when combined with postoperative procalcitonin levels [23,24]. Postoperative CRP is now widely accepted and routinely used for predicting postoperative leak following colorectal surgery.…”

Feasibility and safety of specimen extraction via an enlarged (U-Plus) skin bridge loop ileostomy: a single-center retrospective comparative study

“…The routine procedure for the treatment of low rectal cancer internationally is still laparoscopic low anterior resection (LAR), but anastomotic leak (AL) is one of the most serious complications of this procedure (1). And it is now generally accepted that protected ileostomy reduces the incidence of clinically relevant AL and the risk of unplanned reoperation without increasing mortality (2,3).…”