title: C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery: pilot study in 100 patients.
abstract: BACKGROUND
  Anastomotic leakage is the most important complication after colorectal surgery. Its prognosis depends on its early diagnosis. C-reactive protein (CRP) has already shown its usefulness for the early detection of anastomotic leaks. Procalcitonin (PCT) is widely used in intensive care units and is more expensive, but its usefulness in the postoperative period of digestive surgery is not well established.
  
  
  METHODS
  Between May 2010 and June 2011, 100 patients undergoing elective colorectal surgery were prospectively included in a database. CRP and PCT were measured before surgery and daily until postoperative day 4. All intraabdominal infections were considered as anastomotic leaks, regardless of their clinical impact and their management. The kinetics of PCT and CRP were recorded, as well as their accuracy for the detection of anastomotic fistula.
  
  
  RESULTS
  The incidence of fistula was 13% and the overall mortality rate was 2%. Both CRP and PCT were significantly higher in patients with leakage. Areas under the receiver-operating characteristics (ROC) for CRP were higher than those for PCT each day. The best accuracy was obtained for CRP on postoperative day 4 (areas under the ROC curve were 0.869 for CRP and 0.750 for PCT).
  
  
  CONCLUSIONS
  Procalcitonin is neither earlier nor more accurate than CRP for the detection of anastomotic leakage after elective colorectal surgery.
authors.affiliation: Service de chirurgie digestive et cancérologique, CHU de Dijon, 14, rue Gaffarel, 21079 Dijon cedex, France. n.lagoutte@voila.fr
authors.forename: N
authors.initials: N
authors.lastname: Lagoutte
authors.forename: O
authors.initials: O
authors.lastname: Facy
authors.forename: A
authors.initials: A
authors.lastname: Ravoire
authors.forename: C
authors.initials: C
authors.lastname: Chalumeau
authors.forename: L
authors.initials: L
authors.lastname: Jonval
authors.forename: P
authors.initials: P
authors.lastname: Rat
authors.forename: P
authors.initials: P
authors.lastname: Ortega-Deballon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000097:blood* / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003106:Colon / Q000601:surgery*; D042241:Early Diagnosis; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012007:Rectum / Q000601:surgery*; D055815:Young Adult
chemical_list: C000606589:CALCA protein, human; C000606591:Calca protein, rat; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide