title: Monitoring of procalcitonin but not interleukin-6 is useful for the early prediction of anastomotic leakage after colorectal surgery.
abstract: BACKGROUND
  Early recognition of patients who have developed anastomotic leakage (AL) after colorectal surgery is crucial for the successful treatment of this complication. The aim of this study was to assess the usefulness of the assessment of procalcitonin (PCT) and interleukin-6 (IL-6) levels in the prognosis of AL.
  
  
  METHODS
  This observational study included 157 patients who underwent major elective colorectal surgery. The most common indications for surgery were cancer and inflammatory bowel diseases. Serum samples were obtained directly before surgery (D0) and 1 day (D1) after surgery, and the relationships between the serum concentrations of PCT and IL-6 and development of AL were assessed.
  
  
  RESULTS
  In total, 10.2% of patients developed post-surgical infections due to AL. PCT levels on D1 were significantly higher in patients who developed AL [2.73 (1.40-4.62)] than in those who recovered without complications [0.2 (0.09-0.44)]. The area under the ROC curve for PCT on D1 was 0.94, 95% CI (0.89-0.98). The sensitivity and specificity of the prediction of an infection were 87% and 87%, respectively, for PCT on D1, which was higher than 1.09 ng/mL. The increase in PCT concentration between D0 and D1 was significantly higher in patients with AL (p<0.001). Patients who developed AL had higher concentrations of IL-6 on D1, but the difference was not significant (p=0.28).
  
  
  CONCLUSIONS
  This study confirms that surgical trauma increases serum PCT concentrations and that the concentration of PCT on D1 can predict AL after colorectal surgery. However, IL-6 is not a good early marker for developing AL.
authors.affiliation: .
authors.forename: Urszula
authors.initials: U
authors.lastname: Zielińska-Borkowska
authors.affiliation: .
authors.forename: Naser
authors.initials: N
authors.lastname: Dib
authors.affiliation: .
authors.forename: Wiesław
authors.initials: W
authors.lastname: Tarnowski
authors.affiliation: .
authors.forename: Tomasz
authors.initials: T
authors.lastname: Skirecki
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D002116:Calcitonin / Q000097:blood*; D003107:Colorectal Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D002116:Calcitonin
keywords: anastomotic leakage; biomarker; interleukin-6; procalcitonin