title: Markers of Perioperative Bowel Complications in Colorectal Surgery Patients.
abstract: Colorectal cancer is a clinical condition whose treatment often involves intestinal resection. Such treatment frequently results in two major gastrointestinal complications after surgery: anastomotic leakage and prolonged ileus. Anastomotic leakage is a serious complication which, more often than not, is diagnosed late; to date, C-reactive protein is the only available diagnostic marker. A monocentric, prospective, open case-control study was performed in patients (n = 117) undergoing colorectal surgery. Intestinal fatty acid binding protein (i-FABP), citrulline, D-lactate, exhaled hydrogen, Escherichia coli genomic DNA, and ischemia modified albumin (IMA) were determined preoperatively, postoperatively, and on the following four consecutive days. Bacterial DNA was not detected in any sample, and i-FABP and D-lactate lacked any distinct potential to detect postoperative bowel complications. Exhaled breath hydrogen content showed unacceptably low sensitivity. However, citrulline turned out to be a specific marker for prolonged ileus on postoperative days 3-4. Using a cut-off value of 20 μmol/L, a sensitivity and specificity of ~75% was achieved on postoperative day 4. IMA was found to be an efficient predictor of anastomosis leak by calculating the difference between preoperative and postoperative values. This test had 100% sensitivity and 80% specificity and 100% negative and 20% positive predictive value.
authors.affiliation: Department of Research and Development, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic.
authors.forename: Radomír
authors.initials: R
authors.lastname: Hyšpler
authors.affiliation: Department of Research and Development, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic.
authors.forename: Alena
authors.initials: A
authors.lastname: Tichá
authors.affiliation: Department of Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Kaška
authors.affiliation: Department of Clinical Chemistry, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Žaloudková
authors.affiliation: Department of Clinical Chemistry, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Plíšková
authors.affiliation: Department of Surgery, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic.
authors.forename: Eduard
authors.initials: E
authors.lastname: Havel
authors.affiliation: Department of Research and Development, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic.
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Zadák
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000097:blood* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002956:Citrulline / Q000097:blood; D015179:Colorectal Neoplasms / Q000601:surgery*; D004269:DNA, Bacterial / Q000097:blood; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006801:Humans; D045823:Ileus / Q000097:blood* / Q000209:etiology; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin; D000075462:Serum Albumin, Human
chemical_list: D015415:Biomarkers; D004269:DNA, Bacterial; D050556:Fatty Acid-Binding Proteins; D012709:Serum Albumin; C561522:ischemia-modified albumin; D002956:Citrulline; D019344:Lactic Acid; D000075462:Serum Albumin, Human