Early prediction of bowel anastomotic leakage using C-reactive protein and procalcitonin

Abstract

Background: While prompt identification of anastomotic leaks is crucial to mitigate clinical repercussions, the delayed diagnosis of such leaks is a common occurrence in routine medical practice. The aim of this study is to evaluate the C-reactive protein (CRP) and Procalcitonin (PCT) predictive values for early anastomotic leakage diagnosis after colorectal surgery. Method: This 16-month prospective cohort research was undertaken at Azadi Teaching Hospital and private institutions. This observational study comprised 44 adults who had primary anastomosis colorectal surgery. Patients were then classified by AL presence or absence. Serum PCT and CRP were analysed on POD 1, 2, 3, 4, and 5 to predict anastomotic leak. Results: The mean patient age was 52.7 years, with 59.1% men and 40.9% females. Right hemicolectomy (29.5%) and colostomy closure (29.5%) were common. Only 2/44 (4.5%) instances experienced anastomotic leak, whereas 20.5% had complications. PCT performed well on POD 3, with sensitivity (94%) and specificity (99%) at 2.86 ng/ml and the highest AUC of 0.98. CRP, especially on POD 4, might predict with a cut-off value of 118.41 mg/L, high sensitivity (97%), specificity (99%), and a large AUC of 0.97. Conclusion: Both PCT, and CPR displayed a good predictive performance as early as day 3, and 4 post- operatively for the detection of major anastomotic leak.