title: Diagnostic Accuracy of Procalcitonin and C-reactive Protein for the Early Diagnosis of Intra-abdominal Infection After Elective Colorectal Surgery: A Meta-analysis.
abstract: OBJECTIVE
  Intra-abdominal infections (IAIs) after elective colorectal surgery impact significantly the short- and long-term outcomes. In the era of fast-track surgery, they often come to light after discharge from hospital. Early diagnosis is therefore essential. C-reactive protein levels have proved to be accurate in this setting. Procalcitonin has been evaluated in several studies with conflicting results. This meta-analysis aimed to compare the predictive abilities of C-reactive protein and procalcitonin in the occurrence of IAIs after elective colorectal surgery.
  
  
  METHODS
  This meta-analysis included studies analyzing C-reactive protein and/or procalcitonin levels at postoperative days 2, 3, 4, and/or 5 as markers of intra-abdominal infection after elective colorectal surgery. Methodological quality was assessed by the QUADAS2 tool. The area under the curve summary receiver-operating characteristic was calculated for each day and each biomarker, using a random-effects model in cases of heterogeneity.
  
  
  RESULTS
  The meta-analysis included 11 studies (2692 patients). An IAI occurred in 8.9% of the patients. On postoperative day 3, area under the curve was 0.80 (95% CI, 0.76-0.85) for C-reactive protein and 0.78 (95% CI, 0.68-0.87) for procalcitonin. On postoperative day 5, their predictive accuracies were 0.87 (95% CI, 0.80-0.93) and 0.90 (95% CI, 0.82-0.98), respectively. The accuracy of C-reactive protein and procalcitonin did not differ at any postoperative day.
  
  
  CONCLUSIONS
  Levels of inflammatory markers under the cutoff value between postoperative days 3 and 5 ensure safe early discharge after elective colorectal surgery. Procalcitonin seems not to have added value as compared to C-reactive protein in this setting.
authors.affiliation: *INSERM, CIC1432, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, Dijon University Hospital, Dijon, France†Department of Digestive Surgery, Dijon University Hospital, Dijon, France‡Department of Surgery, General Surgery 1, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: François
authors.initials: F
authors.lastname: Cousin
authors.forename: Pablo
authors.initials: P
authors.lastname: Ortega-Deballon
authors.forename: Abderrahmane
authors.initials: A
authors.lastname: Bourredjem
authors.forename: Alexandre
authors.initials: A
authors.lastname: Doussot
authors.forename: Valentina
authors.initials: V
authors.lastname: Giaccaglia
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fournel
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D003106:Colon / Q000601:surgery*; D042241:Early Diagnosis; D017558:Elective Surgical Procedures / Q000009:adverse effects; D006801:Humans; D059413:Intraabdominal Infections / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012007:Rectum / Q000601:surgery*
chemical_list: D002116:Calcitonin; D002097:C-Reactive Protein