Diagnostic accuracy of C‐reactive protein, procalcitonin and neutrophils for the early detection of anastomotic leakage after colorectal resection: a multicentric, prospective study. (22nd August 2021)

• Record Type: Journal Article
• Authors: Sala Hernandez, Angela; Frasson, Matteo; García‐Granero, Alvaro; Hervás Marín, David; Laiz Marro, Begoña; Alonso Pardo, Ricardo; Aldrey Cao, Inés; Alvarez Perez, José Antonio; Roque Castellano, Cristina; García González, Jose María; Tabet Almeida, Janine; García‐Granero, Eduardo
• Other Names: Fernández Sandra Núñez investigator.; Calvo Alberto Eduardo Parajó investigator.; Cao Inés Aldrey investigator.; Parrilla Elena Rodríguez‐Portugal investigator.; Perez José Antonio Alvarez investigator.; Cernuda Ricardo Felipe Baldonedo investigator.; Alonso Nuria Truán investigator.; González Leyre Cardo investigator.; Castellano Cristina Roque investigator.; Ramis Eva Maria Nogués investigator.; Molina Gervasio Febles investigator.; Alfaro Ruth Martín investigator.; González Jose María García investigator.; Olabarrieta Marta Santamaría investigator.; Aldama Jorge Cervera investigator.; Almeida Janine Tabet investigator.; Quintana Natalia Uribe investigator.; Marinello Franco investigator.; Prats María Milagros Carrasco investigator.; Manzano Álvaro Martinez investigator.; Fernández Begoña Fadrique investigator.; Pérez Juan de Mata López investigator.; Cacho Jesús Ruíz investigator.; López Laura Mora investigator.; Pla Sheila Serra investigator.; Cotoré Jesús Pedro Paredes investigator.; López Fernando Fernández investigator.; López Natalia Rodríguez investigator.; García Javier Rodríguez investigator.; Scheiding Mónica Millán investigator.; Villaró Francesc Feliu investigator.; Díaz María Olga Maseda investigator.; García Jacinto García investigator.; Alcazar Montero Jose Antonio investigator.; García José García investigator.; Larrainzar Amaia Sanz investigator.; Escartín Jorge investigator.; Fernando Jose investigator.; Sotelo Rocio Ferrer investigator.; Juliani Beatriz Boned investigator.; Muíño Raquel Conde investigator.; Illescas ristina Plata investigator.; Martínez Antonio Salvador investigator.; Pallarés Miriam Cantos investigator.; Botella Miguel García investigator.; Septiem Javier García investigator.; Navarro David Costa investigator.; Pina Estefania Domenech investigator.; Ferrer Maria Luisa Graells investigator.; Simó Manuel Romero investigator.; Broto Nacho Goded investigator.; Hernández Natalia Alonso investigator.; Pascual Jaime Bonnin investigator.; Martinez‐Medeiro Jose Manuel Olea investigator.; Trujillo Roberto Lozoya investigator.; Ruiz Maria Dolores investigator.; Caregnato Andrés Frangi investigator.; Carrillo Rodolfo Rodriguez investigator.; Perez Inés Rubio investigator.; Pascual‐Miguelañez Isabel investigator.; Vázquez Irene Ortega investigator.; Lima Francisca investigator.; Alegre Javier Martínez investigator.; Casado Adolfo Pedro Alonso investigator.; Wagner Gabriela investigator.; del Caño García investigator.; Bernal Juan Carlos investigator.; Molina Francisco Landete investigator.; Benito Jorge Herrador investigator.; Antona Francisco Blanco investigator.; Acín María Rufas investigator.; Sierra Isabel Blesa investigator.; Duarte Angel Reina investigator.; Cerrudo Jaime Jorge investigator.; Maresca Manuel Rodriguez investigator.;
• Is Part Of: Colorectal disease. Volume 23:Number 10(2021)
• Page Start: 2723
• Page End: 2730
• Publication Date: 2021-08-22
• Subjects: anastomotic leakage -- biomarkers -- colorectal surgery -- C‐reactive protein -- neutrophils -- procalcitonin; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.15845
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: The aim was to determine the accuracy of C‐reactive protein (CRP), procalcitonin and neutrophils in the early detection (fourth postoperative day) of anastomotic leakage (AL) after colorectal surgery. Methods: We conducted a multicentre, prospective study that included a consecutive series of patients who underwent colorectal resection with anastomosis without ostomy (September 2015 to December 2017). CRP, procalcitonin and neutrophil values on the fourth postoperative day after colorectal resection along with the postoperative outcome (60‐day AL, morbidity and mortality) were prospectively included in an online, anonymous database. Results: The analysis ultimately included 2501 cases. The overall morbidity and mortality was 30.1% and 1.6%, respectively, and the AL rate was 8.6%. The area under the receiver operating characteristic curve values (95% CI) for detecting AL were 0.84 (0.81–0.87), 0.75 (0.72–0.79) and 0.70 (0.66–0.74) for CRP, procalcitonin and neutrophils, respectively. The best cut‐off level for CRP was 119 mg/l, resulting in 70% sensitivity, 81% specificity and 97% negative predictive value. After laparoscopic resection, the accuracy for CRP and procalcitonin was increased, compared with open resection. The combination of two or three of these biomarkers did not significantly increase their accuracy. Conclusion: On the fourth postoperative day, CRP was the most reliable marker for excluding AL. Its high negative predictive value, especially after laparoscopic resection, allows for safe hospital discharge on the fourth postoperative day. The routine use of procalcitonin or neutrophil counts does not seem to increase the diagnostic accuracy.