Procalcitonin and C-reactive protein as early predictors in patients at high risk of colorectal anastomotic leakage

Abstract

Objective: To assess the diagnostic value of C-reactive protein (CRP) and procalcitonin (PCT) for anastomotic leakage (AL) following colorectal surgery.

Methods: We retrospectively analyzed data for patients who underwent colorectal surgery at our hospital between November 2019 and December 2023. CRP and PCT were measured postoperatively to compare patients with/without AL, and changes were compared between low- and high-risk groups. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic accuracy of CRP and PCT to identify AL in high-risk patients.

Results: Mean CRP was 142.53 mg/L and 189.57 mg/L in the low- and high-risk groups, respectively, on postoperative day (POD)3. On POD2, mean PCT was 2.75 ng/mL and 8.16 ng/mL in low- and high-risk patients, respectively; values on POD3 were 3.53 ng/mL and 14.86 ng/mL, respectively. The areas under the curve (AUC) for CRP and PCT on POD3 were 0.71 and 0.78, respectively (CRP cut-off: 235.64 mg/L; sensitivity: 96%; specificity: 89.42% vs PCT cut-off: 3.94 ng/mL; sensitivity: 86%; specificity: 93.56%; AUC: 0.78). The AUC, sensitivity, and specificity for the combined diagnostic ability of CRP and PCT on POD3 were 0.92, 90%, and 100%, respectively (cut-off: 0.44).

Conclusions: Combining PCT and CRP on POD3 enhances the diagnostic accuracy for AL.

Keywords: C-reactive protein; Procalcitonin; anastomotic leakage; colon leakage score; diagnostic accuracy; postoperative; sensitivity; specificity.

Figure 1.

Average CRP changes over time. CRP, C-reactive protein; AL, anastomotic leak.

Figure 2.

Average PCT changes over time. PCT, procalcitonin; AL, anastomotic leak.

Figure 3.

Receiver operating characteristic (ROC) curve analysis of serum CRP in patients with AL. CRP, C-reactive protein; POD, postoperative day.

Figure 4.

Receiver operating characteristic (ROC) curve analysis of serum PCT in patients with AL. PCT, procalcitonin; POD, postoperative day.

Figure 5.

Receiver operating characteristic (ROC) curve analysis of serum CRP in high-risk patients with AL. CRP, C-reactive protein; POD, postoperative day.

Figure 6.

Adding PCT to CRP significantly enhanced the diagnosis of AL in high-risk patients on POD 3 (AUC: 0.92). CRP, C-reactive protein; POD, postoperative day; PCT, procalcitonin; AUC, area under the curve.