Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage:A prospective observational study  

作　　者：Nuno J G Rama Marlene C C Lages Maria Pedro S Guarino Óscar Lourenço Patrícia C Motta Lima Diana Parente Cândida S G Silva Ricardo Castro Ana Bento Anabela Rocha Fernando Castro-Pocas João Pimente 

机构地区：[1]Colorectal Surgical Division,Leiria Hospital Centre,Leiria 2410-021,Portugal [2]Abel Salazar Biomedical Institute(ICBAS),University of Oporto,Oporto 4099-002,Portugal [3]Center for Innovative Care and Health Technology(ciTechCare),Polytechnic of Leiria,Leiria 2410-541,Portugal [4]Faculty of Economics,CeBER,University of Coimbra,Coimbra 3000-137,Portugal [5]Clinical Pathology Division,Leiria Hospital Centre,Leiria 2410-541,Portugal [6]Surgical Division,Oporto Hospital Centre,Oporto 4099-001,Portugal [7]Department of Gastroenterology,Santo António Hospital,Porto Hospital Center,Porto 4099-001,Portugal [8]Institute of Biomedical Sciences Abel Salazar,University of Porto,Porto 4099-001,Portugal [9]Faculty of Medicine,University of Coimbra,Coimbra 3004-531,Portugal [10]Surgical Division,Montes Claros Hospital,Coimbra 3030-320,Portugal

出　　处：《World Journal of Gastroenterology》2022年第24期2758-2774,共17页世界胃肠病学杂志（英文版）

基　　金：Supported by the Ministry of Health–Incentive Program for the Integration of Care and Valuation of Patients’ Pathways in the National Health Service of Portugal

摘　　要：BACKGROUND Colorectal anastomotic leakage(CAL)is one of the most dreaded complications after colorectal surgery,with an incidence that can be as high as 27%.This event is associated with increased morbidity and mortality;therefore,its early diagnosis is crucial to reduce clinical consequences and costs.Some biomarkers have been suggested as laboratory tools for the diagnosis of CAL.AIM To assess the usefulness of plasma C-reactive protein(CRP)and calprotectin(CLP)as early predictors of CAL.METHODS A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis,from March 2017 to August 2019.Patients were divided into three groups:G1–no complications;G2–complications not related to CAL;and G3–CAL.Five biomarkers were measured and analyzed in the first 5 postoperative days(PODs),namely white blood cell(WBC)count,eosinophil cell count(ECC),CRP,CLP,and procalcitonin(PCT).Clinical criteria,such as abdominal pain and clinical condition,were also assessed.The correlation between biomarkers and CAL was evaluated.Receiver operating characteristic(ROC)curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL,and the area under the ROC curve(AUROC),specificity,sensitivity,positive predictive value,and negative predictive value(NPV)during this period were estimated.RESULTS In total,25 of 396 patients developed CAL(6.3%),and the mean time for this diagnosis was 9.0±6.8 d.Some operative characteristics,such as surgical approach,blood loss,intraoperative complications,and duration of the procedure,were notably related to the development of CAL.The length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications(median of 21 d vs 13 d and 7 d respectively;P<0.001).For abdominal pain,the best predictive performance was on POD4 and POD5,with the largest AUROC of 0.84 on POD4.Worsening of the clinical condition was associated

关 键 词：Anastomotic leakage COLORECTAL SURGERY Biomarkers C-reactive protein CALPROTECTIN 

分 类 号：R656.9[医药卫生—外科学]