Yıl: 2021 Cilt: 1 Sayı: 37 Sayfa Aralığı: 22 - 27 Metin Dili: İngilizce İndeks Tarihi: 13-05-2022

Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study

Öz:
Objective: Anastomotic leak can adversely affect the outcome of surgery especially if detected late. The present study was carried out to detect the anastomotic leak early in the postoperative period using serial estimation of procalcitonin (PCT) and C-reactive protein (CRP). Material and Methods: A single centre prospective cohort study was done on patients undergoing elective gastrointestinal surgery with anastomosis. Serial estimation of serum procalcitonin and C reactive protein was done on the first five postoperative days. Other parameters such as hemoglobin, total protein, albumin and WBC counts were noted perioperatively. Patients were followed up to 60th postoperative day to assess for anastomotic leak, wound infection and other septic foci. Results: Eighty-four patients were included in the study. Anastomotic leak rate was 26.19% (22/84) and 3/22 patients died in the anastomotic leak group. Wound infection rate was 23.81%. The cut off value of CRP on third postoperative day in detecting anastomotic leak was 44.322 mg/dl with sensitivity of 72.73%, specificity of 66.13% and accuracy of 59.52%. The cut off value for WBC count measured perioperatively in detecting anastomotic leak was 9470 cell/mm3 with sensitivity of 72.73%, specificity of 56.45% and accuracy of 59.74%. Serum procalcitonin, haemoglobin, total protein and albumin measured were not sensitive enough to detect the anastomotic leak early. Conclusion: Measuring CRP on the third postoperative day can predict anastomotic leak with a cut off value of 44.32 mg/dl. Patients with raised CRP need careful evaluation to rule out anastomotic leak before deciding on early discharge.
Anahtar Kelime:

Elektif bağırsak cerrahisi sonrası anastomoz kaçağının erken tespiti için serum C-reaktif proteininin ve prokalsitoninin seri tetkiki: prospektif kohort çalışma

Öz:
Giriş ve Amaç: Anastomoz kaçağı, özelikle de geç tanı konulduğunda cerrahi sonuçlarını kötü etkileyebilir. Bu çalışmada, anastomoz kaçağının postoperatif erken dönemde tespit edilmesi için C-reaktif protein (CRP) ve prokalsitonin (PCT) seri değerlendirmesi kullanılmıştır. Gereç ve Yöntem: Anastomoz uygulanmış elektif gastroinstestinal cerrahi hastalarını içeren tek merkezli prospektif bir çalışma yürütüldü. İlk beş postoperatif günde C-reaktif protein (CRP) ve prokalsitonin (PCT) seri olarak incelendi. Hemoglobin, total protein, albümin ve beyaz küre sayısı gibi diğer parametreler perioperatif olarak not edildi. Hastalar anastomoz kaçağı, yara enfeksiyonu ve diğer septik odakları değerlendirmek üzere cerrahi sonrası 60. güne kadar takip edildi. Bulgular: Çalışmaya 84 hasta dahil edildi. Anastomoz kaçağı oranı %26,19 idi (22/84) ve anastomoz kaçağı grubunda 3/22 hasta kaybedildi. Yara enfeksiyon oranı %23,81 idi. Anastomoz kaçağını tespit etmede CRP cut-off değeri 44,322 mg/dl iken duyarlılık %72,73, özgüllük %66,13 ve doğruluk %59,74 olarak ölçüldü. Ölçülen serum prokalsitonin, hemoglobin, total protein ve albumin değerleri anastomoz kaçağının erken tespiti için yeterince duyarlı değildi. Sonuç: Üçüncü postoperatif günde CRP ölçümü anastomoz kaçağını 44,32 mg/dl’lik cut-off değeri ile öngörebilir. Yüksek CRP değeri olan hastalarda erken taburculuğa karar vermeden önce anastomoz kaçağının elenmesi gerekmektedir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Shogan BD, An GC, Schardey HM, Matthews JB, Umanskiy K, Fleshman JW, et al. Proceedings of the first international summit on intestinal anastomotic leak, Chicago, Illinois, October 4-5, 2012. Surg Infect 2014; 15(5): 479-89. [CrossRef]
  • 2. Nikolian VC, Kamdar NS, Regenbogen SE, Morris AM, Byrn JC, Suwanabol PA, et al. Anastomotic leak after colorectal resection: A population- based study of risk factors and hospital variation. Surgery 2017; 161(6): 1619–27. [CrossRef]
  • 3. Park JK, Kim JJ, Moon SW. C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis. J Thorac Dis 2017; 9(10): 3693-702. [CrossRef]
  • 4. Hayati F, Azman ZAM, Nasuruddin DN, Mazlan L, Zakaria AD, Sagap I. Serum procalcitonin predicts anastomotic leaks in colorectal surgery. Asian Pac J Cancer Prev 2017; 18(7): 1821-5. [CrossRef]
  • 5. Schaheen L, Blackmon SH, Nason KS. Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg 2014; 208(4): 536-43. [CrossRef]
  • 6. Morks AN, Ploeg RJ, Sijbrand Hofker H, Wiggers T, Havenga K. Late anastomotic leakage in colorectal surgery: a significant problem. Colorectal Dis Off J Assoc Coloproctology G B Irel 2013; 15(5): e271-5. [CrossRef]
  • 7. Muñoz JL, Alvarez MO, Cuquerella V, Miranda E, Picó C, Flores R, et al. Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program. Surg Endosc 2018; 32(9): 4003-10. [CrossRef]
  • 8. Garcia-Granero A, Frasson M, Flor-Lorente B, Blanco F, Puga R, Carratalá A, et al. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum 2013; 56(4): 475-83. [CrossRef]
  • 9. Aiolfi A, Asti E, Rausa E, Bonavina G, Bonitta G, Bonavina L. Use of C-reactive protein for the early prediction of anastomotic leak after esophagectomy: Systematic review and Bayesian meta-analysis. PloS One 2018; 13(12): e0209272. [CrossRef]
  • 10. Gordon AC, Cross AJ, Foo EW, Roberts RH. C-reactive protein is a useful negative predictor of anastomotic leak in oesophago-gastric resection. ANZ J Surg 2018; 88(3): 223-7. [CrossRef]
  • 11. Davis KA, Crow JA, Chambers HW, Meek EC, Chambers JE. Racial differences in paraoxonase-1 (PON1): a factor in the health of southerners? Environ Health Perspect 2009; 117(8): 1226-31. [CrossRef]
  • 12. Jain S, Sinha S, Sharma SK, Samantaray JC, Aggrawal P, Vikram NK, et al. Procalcitonin as a prognostic marker for sepsis: a prospective observational study. BMC Res Notes 2014; 7: 458. [CrossRef]
  • 13. Hill VL, Simpson VZ, Higgins JM, Hu Z, Stevens RA, Metcalf JA, et al. Evaluation of the performance of the sysmex xt-2000i hematology analyzer with whole bloods stored at room temperature. Lab Med 2009; 40(12): 709-18. [CrossRef]
  • 14. Mao X, Shao J, Zhang B, Wang Y. Evaluating analytical quality in clinical biochemistry laboratory using Six Sigma. Biochem Medica 2018; 28(2). [CrossRef]
  • 15. Gessler B, Eriksson O, Angenete E. Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis 2017; 32(4): 549-56. [CrossRef]
  • 16. Malya FU, Hasbahceci M, Tasci Y, Kadioglu H, Guzel M, Karatepe O, et al. The role of c-reactive protein in the early prediction of serious pancreatic fistula development after pancreaticoduodenectomy. Gastroenterol Res Pract 2018; 2018: 9157806. [CrossRef]
  • 17. Hiyoshi M, Chijiiwa K, Fujii Y, Imamura N, Nagano M, Ohuchida J. Usefulness of drain amylase, serum C-reactive protein levels and body temperature to predict postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg 2013; 37(10): 243-42. [CrossRef]
  • 18. Snijders HS, Wouters MWJM, van Leersum NJ, Kolfschoten NE, Henneman D, de Vries AC, et al. Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Surg Oncol 2012; 38(11): 1013-9. [CrossRef]
  • 19. Vasiliu ECZ, Zarnescu NO, Costea R, Neagu S. Review of risk factors for anastomotic leakage in colorectal surgery. Chir Buchar Rom 2015; 110(4): 319-26. [CrossRef]
APA Devarajan J, Anandhi A, g s s, SURESHKUMAR S, shaikh O, Kate V, Vairappan B (2021). Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. , 22 - 27.
Chicago Devarajan Jebin Aaron,Anandhi Amaranathan,g s sreenath,SURESHKUMAR Sathasivam SureshKumar,shaikh Oseen,Kate Vikram,Vairappan Balasubramaniyan Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. (2021): 22 - 27.
MLA Devarajan Jebin Aaron,Anandhi Amaranathan,g s sreenath,SURESHKUMAR Sathasivam SureshKumar,shaikh Oseen,Kate Vikram,Vairappan Balasubramaniyan Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. , 2021, ss.22 - 27.
AMA Devarajan J,Anandhi A,g s s,SURESHKUMAR S,shaikh O,Kate V,Vairappan B Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. . 2021; 22 - 27.
Vancouver Devarajan J,Anandhi A,g s s,SURESHKUMAR S,shaikh O,Kate V,Vairappan B Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. . 2021; 22 - 27.
IEEE Devarajan J,Anandhi A,g s s,SURESHKUMAR S,shaikh O,Kate V,Vairappan B "Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study." , ss.22 - 27, 2021.
ISNAD Devarajan, Jebin Aaron vd. "Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study". (2021), 22-27.
APA Devarajan J, Anandhi A, g s s, SURESHKUMAR S, shaikh O, Kate V, Vairappan B (2021). Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. Turkish Journal of Surgery, 1(37), 22 - 27.
Chicago Devarajan Jebin Aaron,Anandhi Amaranathan,g s sreenath,SURESHKUMAR Sathasivam SureshKumar,shaikh Oseen,Kate Vikram,Vairappan Balasubramaniyan Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. Turkish Journal of Surgery 1, no.37 (2021): 22 - 27.
MLA Devarajan Jebin Aaron,Anandhi Amaranathan,g s sreenath,SURESHKUMAR Sathasivam SureshKumar,shaikh Oseen,Kate Vikram,Vairappan Balasubramaniyan Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. Turkish Journal of Surgery, vol.1, no.37, 2021, ss.22 - 27.
AMA Devarajan J,Anandhi A,g s s,SURESHKUMAR S,shaikh O,Kate V,Vairappan B Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. Turkish Journal of Surgery. 2021; 1(37): 22 - 27.
Vancouver Devarajan J,Anandhi A,g s s,SURESHKUMAR S,shaikh O,Kate V,Vairappan B Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study. Turkish Journal of Surgery. 2021; 1(37): 22 - 27.
IEEE Devarajan J,Anandhi A,g s s,SURESHKUMAR S,shaikh O,Kate V,Vairappan B "Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study." Turkish Journal of Surgery, 1, ss.22 - 27, 2021.
ISNAD Devarajan, Jebin Aaron vd. "Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study". Turkish Journal of Surgery 1/37 (2021), 22-27.