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C-reactive Protein and Procalcitonin Levels to Predict Anastomotic Leak After Colorectal Surgery: Systematic Review and Meta-analysis

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Anastomotic leak (AL) is a feared complication after colorectal surgery. Prompt diagnosis and treatment are crucial. C-reactive protein (CRP) and procalcitonin (PCT) have been proposed as early AL indicators. The aim of this systematic review was to evaluate the CRP and CPT predictive values for early AL diagnosis after colorectal surgery.

Methods

Systematic literature search to identify studies evaluating the diagnostic accuracy of postoperative CRP and CPT for AL. A Bayesian meta-analysis was carried out using a random-effects model and pooled predictive parameters to determine postoperative CRP and PCT cut-off values at different postoperative days (POD).

Results

Twenty-five studies (11,144 patients) were included. The pooled prevalence of AL was 8% (95 CI 7–9%), and the median time to diagnosis was 6.9 days (range 3–10). The derived POD3, POD4 and POD5 CRP cut-off were 15.9 mg/dl, 11.4 mg/dl and 10.9 mg/dl respectively. The diagnostic accuracy was comparable with a pooled area under the curve (AUC) of 0.80 (95% CIs 0.23–0.85), 0.84 (95% CIs 0.18–0.86) and 0.84 (95% CIs 0.18–0.89) respectively. Negative likelihood ratios (LR−) showed moderate evidence to rule out AL on POD 3 (LR− 0.29), POD4 (LR− 0.24) and POD5 (LR− 0.26). The derived POD3 and POD5 CPT cut-off were 0.75 ng/ml (AUC = 0.84) and 0.9 ng/ml (AUC = 0.92) respectively. The pooled POD5 negative LR (−0.18) showed moderate evidence to rule out AL.

Conclusions

In the setting of colorectal surgery, CRP and CPT serum concentrations lower than the derived cut-offs on POD3-POD5, may be useful to rule out AL thus possibly identifying patients at low risk for AL development.

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Authors and Affiliations

  1. Department of Biomedical Science for Health, Division of General Surgery, University of Milan, IRCCS Ospedale Galeazzi - Sant’Ambrogio, Milan, Italy

    Davide Bona, Andrea Sozzi, Marcello Sanzi, Luigi Cayre, Francesca Lombardo, Gianluca Bonitta & Alberto Aiolfi

  2. Department of Biomedical and Clinical Sciences, “Luigi Sacco” Hospital, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy

    Piergiorgio Danelli

  3. Department of Surgery, University of Insubria, IRCCS Ospedale Galeazzi - Sant’Ambrogio, Milan, Italy

    Marta Cavalli & Giampiero Campanelli

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  1. Davide Bona
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Contributions

AA, AS, LC and MS did the literature search. AA and DB formed the study design. Data collection was done by AA, MS and FL. AA, GB, GC and DB analysed the data. AA, PD and DB interpreted the data. AA, GB, and DB wrote the manuscript. All authors critically reviewed the manuscript.

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Correspondence to Alberto Aiolfi.

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Bona, D., Danelli, P., Sozzi, A. et al. C-reactive Protein and Procalcitonin Levels to Predict Anastomotic Leak After Colorectal Surgery: Systematic Review and Meta-analysis. J Gastrointest Surg 27, 166–179 (2023). https://doi.org/10.1007/s11605-022-05473-z

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