Role of the triad of procalcitonin, C-reactive protein, and white blood cell count in the prediction of anastomotic leak following colorectal resections
(2022) In World Journal of Surgical Oncology 20(1).- Abstract
Purpose: The enhanced recovery after surgery (ERAS) program expedites patient recovery after major surgery. This study aimed to investigate the role of the triad of procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC) trajectories as a predictive biomarker for the anastomotic leak (AL) after colorectal surgery. Method: Patients who had colorectal anastomosis were prospectively included. Postoperative clinical and laboratory parameters and outcomes were collected and analyzed. The 5-day trajectories of PCT, CRP, and WBC were evaluated. Based on the trajectory of the three biomarkers, we compared patients with and without AL as detected during the first 30 days after surgery using the area under receiver operator... (More)
Purpose: The enhanced recovery after surgery (ERAS) program expedites patient recovery after major surgery. This study aimed to investigate the role of the triad of procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC) trajectories as a predictive biomarker for the anastomotic leak (AL) after colorectal surgery. Method: Patients who had colorectal anastomosis were prospectively included. Postoperative clinical and laboratory parameters and outcomes were collected and analyzed. The 5-day trajectories of PCT, CRP, and WBC were evaluated. Based on the trajectory of the three biomarkers, we compared patients with and without AL as detected during the first 30 days after surgery using the area under receiver operator characteristic curves (AUC) for logistic estimation. Results: This study included 205 patients, of whom 56% were men and 43.9% were women with a mean age of 56.4 ± 13.1 years. Twenty-two patients (10.7%) had AL; 77.3% underwent surgery, and 22.7% were treated with drainage and antibiotics. Procalcitonin was the best predictor for AL compared to CRP and WBC at three days postoperatively (AUC: 0.84, 0.76, 0.66, respectively). On day 5, a cutoff value of 4.93 ng/mL for PCT had the highest sensitivity, specificity, and negative predictive value. The predictive power of PCT was substantially improved when combined with either CRP or WBC, or both (AUC: 0.92, 0.92, 0.93, respectively). Conclusion: The 5-day trajectories of combined CRP, PCT, and WBC had a better predictive power for AL than the isolated daily measurements. Combining the three parameters may be a reliable predictor of early patient discharge, which would be highly beneficial to ERAS programs.
(Less)
- author
- El Zaher, Haidi Abd ; Ghareeb, Waleed M. ; Fouad, Ahmed M. ; Madbouly, Khaled ; Fathy, Hamada ; Vedin, Tomas LU ; Edelhamre, Marcus LU ; Emile, Sameh H. and Faisal, Mohammed
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Anastomotic leakage, Biomarker, C-reactive protein, Colorectal surgery, Procalcitonin
- in
- World Journal of Surgical Oncology
- volume
- 20
- issue
- 1
- article number
- 33
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85124636247
- pmid:35151339
- ISSN
- 1477-7819
- DOI
- 10.1186/s12957-022-02506-4
- language
- English
- LU publication?
- yes
- id
- 1436ef31-1ffe-402d-b159-0d99bb2a8829
- date added to LUP
- 2022-04-12 11:10:04
- date last changed
- 2024-07-15 02:07:58
@article{1436ef31-1ffe-402d-b159-0d99bb2a8829,
abstract = {{<p>Purpose: The enhanced recovery after surgery (ERAS) program expedites patient recovery after major surgery. This study aimed to investigate the role of the triad of procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC) trajectories as a predictive biomarker for the anastomotic leak (AL) after colorectal surgery. Method: Patients who had colorectal anastomosis were prospectively included. Postoperative clinical and laboratory parameters and outcomes were collected and analyzed. The 5-day trajectories of PCT, CRP, and WBC were evaluated. Based on the trajectory of the three biomarkers, we compared patients with and without AL as detected during the first 30 days after surgery using the area under receiver operator characteristic curves (AUC) for logistic estimation. Results: This study included 205 patients, of whom 56% were men and 43.9% were women with a mean age of 56.4 ± 13.1 years. Twenty-two patients (10.7%) had AL; 77.3% underwent surgery, and 22.7% were treated with drainage and antibiotics. Procalcitonin was the best predictor for AL compared to CRP and WBC at three days postoperatively (AUC: 0.84, 0.76, 0.66, respectively). On day 5, a cutoff value of 4.93 ng/mL for PCT had the highest sensitivity, specificity, and negative predictive value. The predictive power of PCT was substantially improved when combined with either CRP or WBC, or both (AUC: 0.92, 0.92, 0.93, respectively). Conclusion: The 5-day trajectories of combined CRP, PCT, and WBC had a better predictive power for AL than the isolated daily measurements. Combining the three parameters may be a reliable predictor of early patient discharge, which would be highly beneficial to ERAS programs.</p>}},
author = {{El Zaher, Haidi Abd and Ghareeb, Waleed M. and Fouad, Ahmed M. and Madbouly, Khaled and Fathy, Hamada and Vedin, Tomas and Edelhamre, Marcus and Emile, Sameh H. and Faisal, Mohammed}},
issn = {{1477-7819}},
keywords = {{Anastomotic leakage; Biomarker; C-reactive protein; Colorectal surgery; Procalcitonin}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{World Journal of Surgical Oncology}},
title = {{Role of the triad of procalcitonin, C-reactive protein, and white blood cell count in the prediction of anastomotic leak following colorectal resections}},
url = {{http://dx.doi.org/10.1186/s12957-022-02506-4}},
doi = {{10.1186/s12957-022-02506-4}},
volume = {{20}},
year = {{2022}},
}