Role of the triad of procalcitonin, C-reactive protein, and white blood cell count in the prediction of anastomotic leak following colorectal resections

World Journal of Surgical Oncology

Khaled Madbouly¹  Sameh H. Emile²  Ahmed M. Fouad³  Tomas Vedin⁴  Marcus Edelhamre⁴  Waleed M. Ghareeb⁵  Haidi Abd El Zaher⁶  Hamada Fathy⁶  Mohammed Faisal⁷ 

[1] Colorectal Surgery Unit, Alexandria University, School of Medicine, Alexandria, Egypt;Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospital, Mansoura, Egypt;Department of Public Health, Community Medicine, Occupational & Environmental Medicine, Faculty of Medicine, Suez Canal University, Fuzhou, China;Department of Surgery, Helsingborg Hospital, University of Lund 251 87, Helsingborg, Sweden;Gastrointestinal Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt;Faculty of Medicine, Suez Canal University, Ismailia, Egypt;Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt;Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt;General Surgery Department, Sahlgrenska University Hospital, Gothenburg, Sweden;

关键词: Procalcitonin;    C-reactive protein;    Anastomotic leakage;    Colorectal surgery;    Biomarker;   

DOI  :  10.1186/s12957-022-02506-4

来源: Springer

【 摘 要 】

PurposeThe enhanced recovery after surgery (ERAS) program expedites patient recovery after major surgery. This study aimed to investigate the role of the triad of procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC) trajectories as a predictive biomarker for the anastomotic leak (AL) after colorectal surgery.MethodPatients who had colorectal anastomosis were prospectively included. Postoperative clinical and laboratory parameters and outcomes were collected and analyzed. The 5-day trajectories of PCT, CRP, and WBC were evaluated. Based on the trajectory of the three biomarkers, we compared patients with and without AL as detected during the first 30 days after surgery using the area under receiver operator characteristic curves (AUC) for logistic estimation.ResultsThis study included 205 patients, of whom 56% were men and 43.9% were women with a mean age of 56.4 ± 13.1 years. Twenty-two patients (10.7%) had AL; 77.3% underwent surgery, and 22.7% were treated with drainage and antibiotics. Procalcitonin was the best predictor for AL compared to CRP and WBC at three days postoperatively (AUC: 0.84, 0.76, 0.66, respectively). On day 5, a cutoff value of 4.93 ng/mL for PCT had the highest sensitivity, specificity, and negative predictive value. The predictive power of PCT was substantially improved when combined with either CRP or WBC, or both (AUC: 0.92, 0.92, 0.93, respectively).ConclusionThe 5-day trajectories of combined CRP, PCT, and WBC had a better predictive power for AL than the isolated daily measurements. Combining the three parameters may be a reliable predictor of early patient discharge, which would be highly beneficial to ERAS programs.

【 授权许可】

CC BY