title: Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery.
abstract: OBJECTIVE
  Procalcitonin (PCT) is a biomarker used to help sepsis diagnosing and monitoring and guide antibiotic therapy. Anastomotic leak (AL) after colorectal surgery is a severe complication associated with relevant short- and long-term sequelae. The aim of our study is to assess the predictive value of PCT levels to early diagnose AL after colorectal surgery.
  
  
  METHODS
  Between September 2011 and September 2012, a series of 99 patients underwent colorectal surgery in our institution. In all cases, white blood cell (WBC) count, C-reactive protein (CRP), and PCT levels were measured in first, third, and fifth postoperative day (POD). Anastomotic leaks and all other postoperative complications were recorded.
  
  
  RESULTS
  We registered 7 ALs (7.1%). Decreased PCT levels had a significant negative predictive value (NPV) for AL in third and fifth POD (96.7% and 96.7%, respectively), compared with CRP and WBC. The best diagnostic performance was obtained with the combination of PCT and CRP measurements in third and fifth POD (area under the curve, 0.87 and 0.94, respectively). In 5th POD, PCT improves diagnosis, but not in a statistically significant way (area under the curve, 0.86).
  
  
  CONCLUSIONS
  Compared with more established biochemical values such as CRP and WBC, PCT is an earlier, more sensitive, and reliable marker of AL. Increased PCT levels in early PODs after colorectal surgery may provide a more effective way to detect AL, before clinical symptoms appear. Moreover, normal PCT values might be also a useful marker to facilitate a safe and early discharge of selected patients after colorectal surgery.
authors.affiliation: Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. Electronic address: v.giaccaglia@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Giaccaglia
authors.affiliation: Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: P F
authors.initials: PF
authors.lastname: Salvi
authors.affiliation: Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: G V
authors.initials: GV
authors.lastname: Cunsolo
authors.affiliation: Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Sparagna
authors.affiliation: Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: M S
authors.initials: MS
authors.lastname: Antonelli
authors.affiliation: Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Nigri
authors.affiliation: Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Balducci
authors.affiliation: Department of Surgery, General Surgery 1 and Emergency Surgery Units, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ziparo
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: Anastomotic leak; Colorectal surgery; Enhanced recovery after surgery; Procalcitonin