title: C-reactive Protein is a Useful Marker for Early Prediction of Anastomotic Leakage after Esophageal Reconstruction.
abstract: BACKGROUND
  Esophageal anastomotic leakage is one of the most fatal complications after esophagectomy and increases the hospitalization length. We aimed to identify a convenient clinical marker of anastomotic leakage in the early postoperative period.
  
  
  METHODS
  In total, 108 patients who underwent esophagectomy were retrospectively screened, and 96 were used to validate the overall results. All 108 patients underwent physical examinations and determination of their white blood cell count, C-reactive protein level, platelet count, fibrinogen level, fibrin degradation product level, and antithrombin III level until postoperative day 6.
  
  
  RESULTS
  Anastomotic leakage occurred in 21 of the 108 patients (median detection, 8 days). The C-reactive protein level on postoperative day 3 and fibrinogen level on postoperative day 4 in the leakage group were significantly higher than those in the nonleakage group. Receiver operating characteristic curves for detection of anastomotic leakage were constructed; the cutoff value of C-reactive protein on postoperative day 3 was 8.62 mg/dL, and that of fibrinogen on postoperative day 4 was 712 mg/dL. Anastomotic leakage occurred in 23 of the 96 patients in the validation group. There was a significant difference between the leakage and nonleakage groups when the C-reactive protein threshold on postoperative day 3 was set at 8.62 mg/dL. However, there was no difference between the groups when the fibrinogen threshold on postoperative day 4 was set at 712 mg/dL.
  
  
  CONCLUSIONS
  The C-reactive protein level on postoperative day 3 is a valuable predictor of anastomotic leakage after esophagectomy and might allow for earlier management of this complication.
authors.forename: Eijiro
authors.initials: E
authors.lastname: Edagawa
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Ken
authors.initials: K
authors.lastname: Gyobu
authors.forename: Shigeru
authors.initials: S
authors.lastname: Lee
authors.forename: Satoru
authors.initials: S
authors.lastname: Kishida
authors.forename: Yushi
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Ryoya
authors.initials: R
authors.lastname: Hashiba
authors.forename: Harushi
authors.initials: H
authors.lastname: Osugi
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000097:blood* / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D042241:Early Diagnosis; D016629:Esophagectomy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein