Identifying the discriminative value of leukocytes, CRP and Procalcitonin serum level in detecting the anastomosis leakage after gastrointestinal surgery

Ehsan Sobhanian; Aidin Yaghoobi Notash; Zahra Moghimi; Hadi Ahmadi Amoli; Ali Sobhanian; Ehsan Sadeghian

doi:10.18502/ajs.v6i1.14710

Ehsan Sobhanian MD, General Surgeon,Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Aidin Yaghoobi Notash General Surgeon and Faculty Member, Tehran University of Medical Sciences, Tehran, Iran
Zahra Moghimi Department of Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
Hadi Ahmadi Amoli Sina Trauma and Surgery Research Center, Tehran, University of Medical Sciences, Tehran, Iran
Ali Sobhanian Department of pharma economy, Faculty of pharmacy, Tehran medical science, Islamic azad university, Tehran, Iran
Ehsan Sadeghian MD, General Surgeon,Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ajs.v6i1.14710

Keywords: Anastomosis leakage, gastrointestinal surgery, procalcitonin (PCT), CRP

Abstract

Background: Anastomosis leakage is a pivotal post colorectal surgery, threatening patient survival. Unspecific clinical presentations prolong the diagnostic process, potentially reducing the effectiveness of interventions. This situation has highlighted the need for a biomarker that enables early prediction of anastomosis leakage (AL). Previous studies suggest the potential utility of serum levels of white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT) as biomarkers for early detection of AL. Consequently, the present study was conducted with the aim of investigating the potential correlation of these markers with the occurrence of AL.

Methods: Patients who were referred to the hospitals of Tehran University of Medical Sciences from November 2018 to January 2020 were evaluated for inclusion in the study. After obtaining informed consents, 277 cases were enrolled in the study. Serum levels of WBC, CRP, and PCT were measured preoperatively and up to five days postoperation. A statistical correlation analysis was conducted using SPSS software (version 24).

Results: Among the 277 cases, 14 exhibited AL. The highest sensitivity and specificity for AL were observed for CRP on the second and third post-operative days. PCT, however, showed higher utility on the fourth post-operative day with 57% sensitivity, 56% specificity (p-value = 0.001 for the second day and 0.002 on the third day), and a negative predictive value of 96%. These values changed to 36%, 64%, and 95% respectively on the fifth postoperative day, which remains within the acceptable range (p-value = 0.018).

Conclusions: Both CRP and PCT have potential utility as diagnostic biomarkers for the presence of AL and can significantly accelerate the diagnosis period. For the highest sensitivity and specificity, CRP should be used on the second and third post-operative days. The optimal utility for PCT, however, is on the fourth post-operative day.