title: Predicting Value of Serum Procalcitonin, C-Reactive Protein, Drain Fluid Culture, Drain Fluid Interleukin-6, and Tumor Necrosis Factor-α Levels in Anastomotic Leakage after Rectal Resection.
abstract: BACKGROUND
  Anastomotic leak is the most dreaded septic complication of colorectal surgical procedures. Death is proportional to the time between occurrence and diagnosis of the leakage. Biomarkers, which may help to predict anastomotic leakage before appearance of its clinical features, may be beneficial in preventing adverse outcomes. This study investigates a biomarker that might be useful to predict rectal anastomotic leakage before its clinical presentation.
  
  
  METHODS
  Serum procalcitonin and C-reactive protein (CRP) levels, bacterial proliferation, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels of drain fluid were evaluated in 50 consecutive patients who underwent low anterior resection without diverting ostomy for rectal carcinoma.
  
  
  RESULTS
  Anastomotic leakage occurred in seven of 50 (14%) patients. Serum CRP and procalcitonin levels at post-operative day three were higher in patients with anastomotic leakage (p = 0.01, p = 0.02 respectively). Drain TNF-α values were increased 63.2% on post-operative day five when compared with post-operative day three in patients with anastomotic leakage, but were decreased in patients without leakage. There was no statistical difference for drain IL-6 levels between groups. The bacterial proliferation rate of drain fluid culture in the leakage group was 42.9% at post-operative day three and 85.7% at post-operative day five (p = 0.29 and p = 0.0001, respectively).
  
  
  CONCLUSIONS
  High serum CRP and procalcitonin values on post-operative day three are alarming, and assessment of anastomotic leakage by abdominal imaging with rectal contrast is suggested. In addition, increasing levels of TNF-α and bacterial proliferation in drain fluid are predictive, whereas IL-6 is not.
authors.affiliation: 1 Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University , Istanbul, Turkey .
authors.forename: Ismail Ahmet
authors.initials: IA
authors.lastname: Bilgin
authors.affiliation: 1 Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University , Istanbul, Turkey .
authors.forename: Engin
authors.initials: E
authors.lastname: Hatipoglu
authors.affiliation: 2 Medical Faculty, Department of General Surgery, Acibadem University , Istanbul, Turkey .
authors.forename: Afag
authors.initials: A
authors.lastname: Aghayeva
authors.affiliation: 1 Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University , Istanbul, Turkey .
authors.forename: Akif Enes
authors.initials: AE
authors.lastname: Arikan
authors.affiliation: 3 Clinical Laboratory, Koc University Hospital , Istanbul, Turkey .
authors.forename: Said
authors.initials: S
authors.lastname: Incir
authors.affiliation: 4 Faculty of Medicine, Department of Medical Microbiology, Bahcesehir University , Istanbul, Turkey .
authors.forename: Müzeyyen
authors.initials: M
authors.lastname: Mamal Torun
authors.affiliation: 5 Istanbul Medical Faculty, Department of Biostatistics, Istanbul University , Istanbul, Turkey .
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dirican
authors.affiliation: 1 Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University , Istanbul, Turkey .
authors.forename: Sabri
authors.initials: S
authors.lastname: Erguney
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000473:pathology*; D015415:Biomarkers / Q000032:analysis*; D001826:Body Fluids / Q000737:chemistry; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: C-reactive protein; drain fluid culture; interleukin-6; procalcitonin; rectal anastomotic leakage; tumor necrosis factor-α