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Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study

2022-06-28Journal article Open access
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dc.contributor.authorRama, Nuno J G
dc.contributor.authorLages, Marlene C C
dc.contributor.authorGuarino, Maria Pedro S
dc.contributor.authorLourenço, Óscar
dc.contributor.authorMotta Lima, Patrícia C
dc.contributor.authorParente, Diana
dc.contributor.authorSilva, Cândida S G
dc.contributor.authorCastro, Ricardo
dc.contributor.authorBento, Ana
dc.contributor.authorRocha, Anabela
dc.contributor.authorCastro-Pocas, Fernando
dc.contributor.authorPimentel, João
dc.date.accessioned2023-07-25T17:14:35Z
dc.date.available2023-07-25T17:14:35Z
dc.date.issued2022-06-28
dc.descriptionSupported by the Ministry of Health – Incentive Program for the Integration of Care and Valuation of Patients’ Pathways in the National Health Service of Portugal.pt_PT
dc.description.abstractBACKGROUND: Colorectal anastomotic leakage (CAL) is one of the most dreaded complications after colorectal surgery, with an incidence that can be as high as 27%. This event is associated with increased morbidity and mortality; therefore, its early diagnosis is crucial to reduce clinical consequences and costs. Some biomarkers have been suggested as laboratory tools for the diagnosis of CAL. AIM: To assess the usefulness of plasma C-reactive protein (CRP) and calprotectin (CLP) as early predictors of CAL. METHODS: A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis, from March 2017 to August 2019. Patients were divided into three groups: G1 – no complications; G2 – complications not related to CAL; and G3 – CAL. Five biomarkers were measured and analyzed in the first 5 postoperative days (PODs), namely white blood cell (WBC) count, eosinophil cell count (ECC), CRP, CLP, and procalcitonin (PCT). Clinical criteria, such as abdominal pain and clinical condition, were also assessed. The correlation between biomarkers and CAL was evaluated. Receiver operating characteristic (ROC) curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL, and the area under the ROC curve (AUROC), specificity, sensitivity, positive predictive value, and negative predictive value (NPV) during this period were estimated. RESULTS: In total, 25 of 396 patients developed CAL (6.3%), and the mean time for this diagnosis was 9.0 ± 6.8 d. Some operative characteristics, such as surgical approach, blood loss, intraoperative complications, and duration of the procedure, were notably related to the development of CAL. The length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications (median of 21 d vs 13 d and 7 d respectively; P < 0.001). For abdominal pain, the best predictive performance was on POD4 and POD5, with the largest AUROC of 0.84 on POD4. Worsening of the clinical condition was associated with the diagnosis of CAL, presenting a higher predictive effect on POD5, with an AUROC of 0.9. WBC and ECC showed better predictive effects on POD5 (AUROC = 0.62 and 0.7, respectively). Those markers also presented a high NPV (94%-98%). PCT had the best predictive effect on POD5 (AUROC = 0.61), although it presented low accuracy. However, this biomarker revealed a high NPV on POD3, POD4, and POD5 (96%, 95%, and 96%, respectively). The mean CRP value on POD5 was significantly higher in the group that developed CAL compared with the group without complications (195.5 ± 139.9 mg/L vs 59.5 ± 43.4 mg/L; P < 0.00001). On POD5, CRP had a NPV of 98%. The mean CLP value on POD3 was significantly higher in G3 compared with G1 (5.26 ± 3.58 μg/mL vs 11.52 ± 6.81 μg/mL; P < 0.00005). On POD3, the combination of CLP and CRP values showed a high diagnostic accuracy (AUROC = 0.82), providing a 5.2 d reduction in the time to CAL diagnosis. CONCLUSION: CRP and CLP are moderate predictors of CAL. However, the combination of these biomarkers presents an increased diagnostic accuracy, potentially decreasing the time to CAL diagnosis.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationRama NJG, Lages MCC, Guarino MPS, Lourenço Ó, Motta Lima PC, Parente D, Silva CSG, Castro R, Bento A, Rocha A, Castro-Pocas F, Pimentel J. Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study. World J Gastroenterol 2022; 28(24): 2758-2774 [PMID: 35979163 DOI: 10.3748/wjg.v28.i24.2758] Rama NJG, Lages MCC, Guarino MPS, Lourenço Ó, Motta Lima PC, Parente D, Silva CSG, Castro R, Bento A, Rocha A, Castro-Pocas F, Pimentel J. Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study. World J Gastroenterol 2022; 28(24): 2758-2774 [PMID: 35979163 DOI: 10.3748/wjg.v28.i24.2758]pt_PT
dc.identifier.doi10.3748/wjg.v28.i24.2758pt_PT
dc.identifier.eissn2219-2840
dc.identifier.issn1007-9327
dc.identifier.pmc9260864
dc.identifier.pmid35979163
dc.identifier.urihttp://hdl.handle.net/10400.8/8690
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBaishideng Publishing Grouppt_PT
dc.relation.publisherversionhttps://www.wjgnet.com/1007-9327/full/v28/i24/2758.htmpt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/pt_PT
dc.subjectAnastomotic leakagept_PT
dc.subjectColorectalpt_PT
dc.subjectSurgerypt_PT
dc.subjectBiomarkerspt_PT
dc.subjectC-reactive proteinpt_PT
dc.subjectCalprotectinpt_PT
dc.titleUsefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage2774pt_PT
oaire.citation.issue24pt_PT
oaire.citation.startPage2758pt_PT
oaire.citation.titleWorld Journal of Gastroenterologypt_PT
oaire.citation.volume28pt_PT
person.familyNamerama
person.familyNameLages
person.familyNameGuarino
person.familyNameSilva
person.givenNamenuno
person.givenNameMarlene
person.givenNameMaria Pedro
person.givenNameCândida
person.identifier.ciencia-idE012-FE6B-9A38
person.identifier.ciencia-idC613-4639-10A8
person.identifier.ciencia-idF21A-BD01-2D52
person.identifier.ciencia-idD513-D305-7FD1
person.identifier.orcid0000-0002-1572-2239
person.identifier.orcid0000-0002-7389-6368
person.identifier.orcid0000-0001-6079-1105
person.identifier.orcid0000-0002-7092-1169
person.identifier.ridB-5594-2015
person.identifier.scopus-author-id56348477000
person.identifier.scopus-author-id55429869600
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
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