Key result
C-reactive protein on postoperative day 5 (>54 mg/dL) was a superior early predictor of anastomotic leakage compared to neutrophil-to-lymphocyte ratio (AUC 0.81, sensitivity 89%, specificity 61%).
Why the study?
Anastomotic leakage after colorectal surgery carries high morbidity and mortality, making preclinical markers needed for early diagnosis and timely intervention.
Does CRP or NLR better predict early anastomotic leakage in patients undergoing colorectal surgery?
Cohort (n=116)
Does CRP or NLR better predict early anastomotic leakage in patients undergoing colorectal surgery?
Effect estimate: AUC 0.81
p-value: p=<0.001
CRP is superior to NLR as an early predictor of anastomotic leakage following colorectal surgery, with optimal predictive value on postoperative day 5.
INTRODUCTION: Colorectal surgery (CRS) is associated with high morbidity rates, being anastomotic leakage (AL) one of the most serious complications with an incidence as high as 15%, accounting for up to a third of mortality in these procedures. The identification of pre-clinical markers may allow an early diagnosis and a timely intervention. The objective of the present study was to compare the performance of neutrophil-to-lymphocyte ratio (NLR) vs C-reactive protein (CRP) as early predictors of AL in CRS. METHODS: A retrospectively analyzed consecutive patients who underwent a colorectal surgery with anastomosis from June 2015 to April 2019. Receiver-operating characteristic (ROC) curves were used to find the cutoff points with the best diagnostic performance of AL. RESULTS: A total of 116 patients were included. From 43 patients (37%) who developed a total of 63 complications, 9 (7.76%) presented with an AL with a median of 8 days (range: 5-9). No significant differences were found for NLR between patients with vs without AL. In contrast, median CRP was significantly higher in patients who subsequently presented with AL, both on day 4 (164 vs 64, p = 0.04) and 5 (94 vs 44, p < 0.001) after surgery. The best predictive performance through ROC curves was found on postoperative day 5, with a CRP value of >54 mg/dL (AUC: 0.81, Sensitivity: 89%, Specificity: 61%). CONCLUSIONS: CRP appears superior to NLR as an early predictor of AL following CRS. The best diagnostic performance was obtained on postoperative day 5 with a cutoff value of >54 mg/dL.
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Pachajoa et al. (2021) conducted a cohort in Colorectal surgery with anastomosis (n=116). C-reactive protein (CRP) vs. Neutrophil-to-lymphocyte ratio (NLR) was evaluated on Anastomotic leakage (AL) (AUC 0.81, p=<0.001). C-reactive protein on postoperative day 5 (>54 mg/dL) was a superior early predictor of anastomotic leakage compared to neutrophil-to-lymphocyte ratio (AUC 0.81, sensitivity 89%, specificity 61%).
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