title: Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study.
abstract: BACKGROUND
  Although the early diagnosis of anastomotic leak is a key point in reducing its clinical consequences, in daily practice, anastomotic leak diagnosis is often late.
  
  
  OBJECTIVE
  The aim of this study was to determine whether procalcitonin and C-reactive protein are good predictors of anastomotic leak in colorectal surgery.
  
  
  METHODS
  This is a prospective observational study.
  
  
  METHODS
  This study was conducted by a specialized colorectal multidisciplinary team of a tertiary teaching hospital.
  
  
  METHODS
  A series of 205 consecutive patients who underwent elective colorectal surgery in a specialized unit was prospectively analyzed. The following data were collected: demographic, surgical, ASA class, POSSUM, and morbidity. During the first 5 postoperative days, procalcitonin, C-reactive protein, leukocytes, platelets, and vital signs were evaluated daily.
  
  
  METHODS
  Daily assessment of clinical variable and serological data were conducted in the first 5 postoperative days.
  
  
  METHODS
  The primary outcome measure was the area under the curve at receiving operating characteristic curve analysis of the different variables in relation to the anastomotic leak.
  
  
  RESULTS
  Anastomotic leak was detected in 17 (8.3%) patients; 11(5.4%) of the patients had a major anastomotic leak (need for drainage or reoperation). None of the variables evaluated were shown to be reliable in the early detection of anastomotic leak, considering both minor and major (maximum area under the curve <0.80). In contrast, when considering only major anastomotic leaks, procalcitonin and C-reactive protein were reliable predictors on postoperative days 3 to 5 (p < 0.0001, area under the curve >0.80). The best combination was procalcitonin at postoperative day 5 (area under the curve = 0.86), with a cutoff of 0.31 ng/mL, resulting in a 100% sensitivity, 72% specificity, 100% negative predictive value, and 17% positive predictive value.
  
  
  CONCLUSIONS
  Only symptomatic patients were investigated to rule out anastomotic leakage.
  
  
  CONCLUSIONS
  Procalcitonin and C-reactive protein are both reliable predictors of major anastomotic leak after colorectal resection, although procalcitonin is more accurate. Raised procalcitonin and C-reactive protein serum concentration on postoperative days 3 to 5 renders necessary a careful evaluation of the patient before discharge.
authors.affiliation: Department of General Surgery, Colorectal Unit, Hospital Clinico Universitario, University of Valencia, Valencia, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Garcia-Granero
authors.forename: Matteo
authors.initials: M
authors.lastname: Frasson
authors.forename: Blas
authors.initials: B
authors.lastname: Flor-Lorente
authors.forename: Francisco
authors.initials: F
authors.lastname: Blanco
authors.forename: Ramon
authors.initials: R
authors.lastname: Puga
authors.forename: Arturo
authors.initials: A
authors.lastname: Carratalá
authors.forename: Eduardo
authors.initials: E
authors.lastname: Garcia-Granero
mesh_terms: D057868:Anastomotic Leak / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003106:Colon / Q000601:surgery*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012007:Rectum / Q000601:surgery*; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide