Diagnostic accuracy of C‐reactive protein, procalcitonin and neutrophils for the early detection of anastomotic leakage after colorectal resection: a multicentric, prospective study

• Published in: Colorectal disease Vol. 23; no. 10; pp. 2723 - 2730
• Main 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, Fernández, Sandra Núñez, Calvo, Alberto Eduardo Parajó, Cao, Inés Aldrey, Parrilla, Elena Rodríguez‐Portugal, Perez, José Antonio Alvarez, Cernuda, Ricardo Felipe Baldonedo, Alonso, Nuria Truán, González, Leyre Cardo, Castellano, Cristina Roque, Ramis, Eva Maria Nogués, Molina, Gervasio Febles, Alfaro, Ruth Martín, González, Jose María García, Olabarrieta, Marta Santamaría, Aldama, Jorge Cervera, Almeida, Janine Tabet, Quintana, Natalia Uribe, Marinello, Franco, Prats, María Milagros Carrasco, Manzano, Álvaro Martinez, Fernández, Begoña Fadrique, Pérez, Juan de Mata López, Cacho, Jesús Ruíz, López, Laura Mora, Pla, Sheila Serra, Cotoré, Jesús Pedro Paredes, López, Fernando Fernández, López, Natalia Rodríguez, García, Javier Rodríguez, Scheiding, Mónica Millán, Villaró, Francesc Feliu, Díaz, María Olga Maseda, García, Jacinto García, Alcazar Montero, Jose Antonio, García, José García, Larrainzar, Amaia Sanz, Escartín, Jorge, Fernando, Jose, Sotelo, Rocio Ferrer, Juliani, Beatriz Boned, Muíño, Raquel Conde, Illescas, ristina Plata, Martínez, Antonio Salvador, Pallarés, Miriam Cantos, Botella, Miguel García, Septiem, Javier García, Navarro, David Costa, Pina, Estefania Domenech, Ferrer, Maria Luisa Graells, Simó, Manuel Romero, Broto, Nacho Goded, Hernández, Natalia Alonso, Pascual, Jaime Bonnin, Martinez‐Medeiro, Jose Manuel Olea, Trujillo, Roberto Lozoya, Ruiz, Maria Dolores, Caregnato, Andrés Frangi, Carrillo, Rodolfo Rodriguez, Perez, Inés Rubio, Pascual‐Miguelañez, Isabel, Vázquez, Irene Ortega, Lima, Francisca, Alegre, Javier Martínez, Casado, Adolfo Pedro Alonso, Wagner, Gabriela, del Caño, García, Bernal, Juan Carlos, Molina, Francisco Landete, Benito, Jorge Herrador, Antona, Francisco Blanco, Acín, María Rufas, Sierra, Isabel Blesa, Duarte, Angel Reina, Cerrudo, Jaime Jorge, Maresca, Manuel Rodriguez
• Format: Journal Article
• Language: English
• Published: Chichester Wiley Subscription Services, Inc 01-10-2021
• Subjects: Accuracy; Anastomosis; Anastomotic leak; anastomotic leakage; biomarkers; colorectal surgery; C‐reactive protein; Laparoscopy; Leukocytes (neutrophilic); Morbidity; Mortality; Neutrophils; Procalcitonin
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.15845

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.