title: Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage.
abstract: BACKGROUND
  We aim to determine if C-reactive protein (CRP), lipopolysaccharide-binding protein (LBP), and procalcitonin (PCT) in drain fluid can serve as screening tools for colorectal anastomotic leakage (CAL).
  
  
  METHODS
  Patients included in this multicenter prospective observational study underwent left hemicolectomy, sigmoid resection, high anterior resection, low anterior resection, or subtotal colectomy. During the first 5 postoperative days, CRP, LBP, and PCT were determined on drain fluid.
  
  
  RESULTS
  In total 243 patients were included, of whom 19 (8%) developed CAL. CRP levels were higher in patients with leakage on day 3 and day 5, levels of LBP were higher on days 2, 3, and 4, and PCT levels were higher on day 5. Multivariate analysis showed LBP to be significantly related to CAL. An increase in the average initial value at the first postoperative day with 1 standard deviation increased the risk of leakage by 1.6 times.
  
  
  CONCLUSIONS
  Increased concentrations of LBP in drain fluid are significantly associated to a higher chance of CAL and could contribute in a future prognostic model for CAL.
authors: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: nielskomen@hotmail.com.
authors: Niels
authors: N
authors: Komen
authors: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Juliette
authors: J
authors: Slieker
authors: Department of Surgery, ZNA Middelheim, Antwerp, Belgium.
authors: Paul
authors: P
authors: Willemsen
authors: Department of Surgery, St. Franciscus Gasthuis, Rotterdam, The Netherlands.
authors: Guido
authors: G
authors: Mannaerts
authors: Department of Surgery, University Hospital Ghent, Ghent, Belgium.
authors: Piet
authors: P
authors: Pattyn
authors: Department of Surgery, Reinier de Graaf Groep, Delft, The Netherlands.
authors: Tom
authors: T
authors: Karsten
authors: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors: Hans
authors: H
authors: de Wilt
authors: Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
authors: Erwin
authors: E
authors: van der Harst
authors: Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Yolanda B
authors: YB
authors: de Rijke
authors: Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Magdalena
authors: M
authors: Murawska
authors: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Johannes
authors: J
authors: Jeekel
authors: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Johan F
authors: JF
authors: Lange
mesh_terms: D000209:Acute-Phase Proteins / Q000378:metabolism*; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000378:metabolism*; D015740:Calcitonin Gene-Related Peptide; D002352:Carrier Proteins / Q000378:metabolism*; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism*; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011182:Postoperative Care; D011446:Prospective Studies; D011498:Protein Precursors / Q000378:metabolism*; D012007:Rectum / Q000601:surgery*; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D002097:C-Reactive Protein; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide; D002352:Carrier Proteins; D008562:Membrane Glycoproteins; D011498:Protein Precursors; D000099231:Lipopolysaccharide-Binding Protein; C000606589:CALCA protein, human
keywords: Anastomotic leakage; CRP; Colorectal surgery; Lipopolysaccharide-binding protein; Procalcitonin; Screening