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Early diagnosis of anastomotic leakage in colorectal surgery: prospective observational study of the utility of inflammatory markers and determination of pathological levels

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Abstract

Procalcitonin (PCT) and C-Reactive Protein (CRP) are acute-phase reactants that indicate the presence and severity of an infection. The aim of this study was to verify the utility of CRP and PCT as tools for early diagnosis of anastomotic leakage (AL) in patients undergoing elective colorectal surgery. A prospective observational study including 95 patients undergoing elective colorectal surgery with anastomosis, where patients were divided into two groups according to whether or not AL happened. Different variables were compared using a uni- and multivariate analyses to identify the risk factors for AL. Receiver Operating Characteristic (ROC) curves were added to establish a cut-off point for CRP and PCT. The inflammatory marker levels were analysed in other complications different from AL. AL was detected in 11 patients (14%), 7 required an emergency reoperation. The overall morbidity rate was 42.1% and the mortality was 3.2%. In the univariate study, increased CRP on days 3 and 5, male sex and intraoperative complications were significantly associated with AL. In the multivariate study, CRP on day 5 was the only factor related to AL. AUC at ROC curves showed that CRP results ≥ 15.3 mg/dL on day 3 and 9.1 mg/dL on day 5 were predictors of AL. Normal CRP and PCT values had a high negative predictive value. CRP on postoperative day 5 is a reliable marker for early detection of anastomotic leakage in colorectal surgery. Both CRP and PCT on days 3 and 5 have a high negative predictive value.

Trial registration: The study has been registered at ClinicalTrials.gov. Code: NCT04632446.

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The data and material are available at figshare.com.

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https://doi.org/10.6084/m9.figshare.12130905

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. General and Digestive Surgery Department, Hospital General Universitario Morales Meseguer, IMIB, Avda. Marques de los Velez s/n., 300007, Murcia, Spain

    Melody Baeza-Murcia, Graciela Valero-Navarro, Enrique Pellicer-Franco, Victoriano Soria-Aledo, Monica Mengual-Ballester, Jose Andres Garcia-Marin, Lidia Betoret-Benavente & Jose Luis Aguayo-Albasini

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  1. Melody Baeza-Murcia
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  2. Graciela Valero-Navarro
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  3. Enrique Pellicer-Franco
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  4. Victoriano Soria-Aledo
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  5. Monica Mengual-Ballester
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  6. Jose Andres Garcia-Marin
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  7. Lidia Betoret-Benavente
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  8. Jose Luis Aguayo-Albasini
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Contributions

MBM, GVN and JLAA have designed the study. GVN, EPF, VSA, MMB and JAGM have operated and follow all the patients. MBM and LBB have collect all the data. MBM and GVN have made the statistical analysis. All the authors have discussed the results and approved the paper.

Corresponding author

Correspondence to Graciela Valero-Navarro.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

The study have been approval by the Hospital Ethic Committee.

Research involving human participants and/or animals

The study has been approved by the appropriate institutional and/or national research ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Patients have consented to participate.

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Patients have consented to publication.

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Baeza-Murcia, M., Valero-Navarro, G., Pellicer-Franco, E. et al. Early diagnosis of anastomotic leakage in colorectal surgery: prospective observational study of the utility of inflammatory markers and determination of pathological levels. Updates Surg 73, 2103–2111 (2021). https://doi.org/10.1007/s13304-021-01082-8

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  • DOI: https://doi.org/10.1007/s13304-021-01082-8

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