Diagnostic accuracy of C‐reactive protein, procalcitonin and neutrophils for the early detection of anastomotic leakage after colorectal resection: a multicentric, prospective study
| Autor: | Angela, Sala Hernandez, Matteo, Frasson, Alvaro, García-Granero, David, Hervás Marín, Begoña, Laiz Marro, Ricardo, Alonso Pardo, Inés, Aldrey Cao, José Antonio, Alvarez Perez, Cristina, Roque Castellano, Jose María, García González, Janine, Tabet Almeida, Eduardo, García-Granero, Manuel Rodriguez, Maresca |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Neutrophils Anastomotic Leak Anastomosis Gastroenterology C-reactive protein anastomotic leakage biomarkers colorectal surgery neutrophils procalcitonin Procalcitonin Open Resection Internal medicine Humans Medicine Prospective Studies Prospective cohort study biology Receiver operating characteristic business.industry C-reactive protein bacterial infections and mycoses Colorectal surgery C-Reactive Protein ROC Curve Anastomotic leakage biology.protein Colorectal Neoplasms business Biomarkers hormones hormone substitutes and hormone antagonists |
| Zdroj: | COLORECTAL DISEASE r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe instname |
| ISSN: | 1463-1318 1462-8910 |
| DOI: | 10.1111/codi.15845 |
| Popis: | Aim To determine the accuracy of C-reactive protein, procalcitonin and neutrophils in the early detection (fourth postoperative day) of anastomotic leak (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 neutrophils values on the fourth postoperative day after colorectal resection along with the postoperative outcome (60-day anastomotic leak, 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 anastomotic leakage rate was 8.6%. The area under the receiver operating characteristic (ROC) curve (AUC) values (95% IC) 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 2 or 3 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. |
| Databáze: | OpenAIRE |
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