Key result
Low POD4 CRP excludes anastomotic leak with ~98% negative predictive value.
Why the study?
To evaluate the accuracy and optimal C-reactive protein level for detecting anastomotic leak in patients following elective colorectal resection.
Does C-reactive protein level predict anastomotic leak in patients following elective colorectal resection?
Cohort (n=231)
No
Does C-reactive protein level predict anastomotic leak in patients following elective colorectal resection?
Effect estimate: AUC 0.90
p-value: p=0.001
A CRP level <160 mg/L on postoperative day 4 is an excellent negative predictor of anastomotic leak following elective colorectal resection, potentially facilitating safe early discharge.
May support safe early discharge decisions; hypothesis-generating and requires prospective validation before practice change.
Background To evaluate the accuracy and optimal C-reactive protein (CRP) level for detecting anastomotic leak (AL) in patients following elective colorectal resection. Methods A retrospective data collection of patients undergoing elective colorectal resection with primary anastomosis at a single institution was performed. Data were collected between June 2021 and November 2022. All colorectal resections and any anastomosis type were included. The following information was collected: basic patient demographics, operative and postoperative complications, and daily CRP results for the first seven postoperative days (POD). SPSS version 27 (IBM Corp., Armonk, NY) was used for all data analysis. Results A total of 231 patients with a mean age of 68.8 ± 14.4 years were included. The most common surgical procedure was a right hemicolectomy (46.3%), followed by anterior resection (42.8%), segmental colectomy (7.4%), and subtotal colectomy (3.4%). The overall AL rate for this cohort was 3%, and the median length of hospital stay was six days (mean: 7.6 ± 5.1 days). POD3, POD4, and POD5 showed an area under the curve of 0.73 (P = 0.07), 0.90 (P = 0.001), and 0.95 (P = 0.002), respectively. An optimal CRP cut-off value of 160 mg/L on POD4 resulted in a sensitivity of 85%, specificity of 83%, negative predictive value of 98%, and positive predictive value of 24%. Conclusion CRP is an excellent negative predictor of AL following colorectal resection and primary anastomosis. Patients with a POD4 CRP of <160 mg/L may be earmarked for hospital discharge if clinically appropriate.
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Mohamedahmed et al. (2024) conducted a cohort in Elective colorectal resection with primary anastomosis (n=231). C-reactive protein (CRP) level was evaluated on Detection of anastomotic leak using CRP on postoperative day 4 (AUC 0.90, p=0.001). A C-reactive protein level below 160 mg/L on postoperative day 4 served as an excellent negative predictor for anastomotic leak, demonstrating an area under the curve of 0.90 and a negative predictive value of 98%.
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