Open AccessAnastomotic leakage after elective colorectal surgery: a prospective multicentre observational study on use of the Dutch leakage score, serum procalcitonin and serum C‐reactive protein for diagnosis
Author(s) -
Marco Catarci,
Giacomo Ruffo,
Felice Borghi,
Alberto Patriti,
Paolo Delrio,
Marco Scatizzi,
Stefano Mancini,
Gianluca Garulli,
A. Carrara,
Felice Pirozzi,
Stefano Scabini,
Andrea Liverani,
Gian Luca Baiocchi,
Roberto Campagnacci,
Andrea Muratore,
Graziano Longo,
Marco Caricato,
Raffaele Palmieri,
Nereo Vettoretto,
Paolo Ciano,
Elisa Bertocchi,
Desirée Cianflocca,
M. Lambertini,
Ugo Pace,
Maddalena Baraghini,
Riccardo Angeloni,
Andrea Lucchi,
Giuseppe Tirone,
Antonio Sciuto,
Antonio Martino,
Tatiana Di Cesare,
Sarah Molfino,
Angela Maurizi,
Federico Tomassini,
Gabriella Teresa Capolupo,
Pietro Maria Amodio,
Elisa Arici,
Benedetta Ruggeri,
Gianluca Guercioni
Publication year - 2020
Publication title -
bjs open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.974
H-Index - 9
ISSN - 2474-9842
DOI - 10.1002/bjs5.50269
Subject(s) - procalcitonin , medicine , receiver operating characteristic , gastroenterology , c reactive protein , area under the curve , prospective cohort study , observational study , clinical endpoint , sepsis , surgery , clinical trial , inflammation
Background The purpose of this study was to test use of the Dutch leakage score (DLS), serum C‐reactive protein (CRP) and serum procalcitonin (PCT) in the diagnosis of anastomotic leakage (AL) after elective colorectal resection in a prospective observational study. Methods Patients undergoing elective colorectal resection with anastomosis in 19 centres were enrolled over a 1‐year period from September 2017. The DLS and CRP and PCT levels were evaluated on postoperative day (POD) 2, POD3 and POD6. Statistical analysis, including determination of the area under the receiver operating characteristic (ROC) curve (AUC), was performed for the primary endpoint of AL; secondary endpoints were morbidity and mortality rates ( ClinicalTrials.gov identifier: NCT03560180). Results Among 1546 patients enrolled, the AL rate was 4·9 per cent. Morbidity and mortality rates were 30·2 and 1·3 per cent respectively. With respect to AL, DLS performed better than CRP and PTC levels on POD2 and POD3 (AUC 0·75 and 0·84), whereas CRP levels were documented with better AUC values on POD6 (AUC 0·81). Morbidity was poorly predicted, whereas mortality was best predicted by PCT on POD2 (AUC 0·83) and by DLS on POD3 and POD6 (AUC 0·87 and 0·98 respectively). Overall, the combination of positive PCT, CRP and DLS values resulted in a probability of AL of 21·3 per cent on POD2, 33·4 per cent on POD3, and 47·1 per cent on POD6. However, the combination of their negative values excluded AL in 99·0 per cent of cases on POD2, 99·3 per cent on POD3, and 99·2 per cent on POD6. Conclusion DLS and CRP level are good positive and excellent negative predictors of AL; the addition of PCT improved the predictive value for diagnosis of AL.