Key result
Elevated postoperative CRP reliably predicts early colorectal anastomotic leakage, especially alongside PCT and clinical scores.
Why the study?
Anastomotic leakage after colon and rectal surgery is a serious complication with increased mortality and morbidity, and there is a need to evaluate blood markers for early diagnosis.
Do blood markers such as CRP and PCT predict anastomotic leakage early after colorectal surgery?
Systematic Review
Do blood markers such as CRP and PCT predict anastomotic leakage early after colorectal surgery?
CRP, alone or combined with PCT and clinical scores, is a reliable early biomarker for predicting anastomotic leakage after colorectal surgery.
Supports routine CRP monitoring augmented by PCT and clinical scores for early leak detection after colorectal surgery; reinforces Level 1 systematic review evidence.
Leakage of the anastomotic site is considered to be one of the most serious complications after colon and rectal surgery. It is associated with increased mortality, morbidity, and longer hospital stays. This systematic review examines the need for blood markers such as C-reactive protein (CRP), procalcitonin (PCT), albumin, and various other molecular markers that assist in their propensity to diagnose anastomotic leakage (AL) early after surgery. Utilizing PubMed and Google Scholar as resources and including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the articles, and studies over the last five years were included. A total of 12 studies have been discussed, and most articles suggest CRP as an excellent indicator. CRP compared to Dutch leakage scores (DLS) and PCT studies suggest that the three combinations improve the predictable outcome of AL. In addition, CRP and PCT have been shown to diagnose AL early in the postoperative period. Other studies include the role of markers of oxidative stress markers, Interleukin-6, Interleukin-10, and other molecular markers in the peritoneal drain which are predictive for identifying AL after three days postoperatively (POD-3). Overall, CRP has proven to be a reliable standard indicator of diagnosis. This is because the postoperative elevation of this protein indicates a problem of leakage with clinical symptoms. Other blood parameters are useful for diagnosis as well, but the limitations are the lack of appropriate studies and the number of randomized controlled trials in this area of study.
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Selvamani et al. (2022) conducted a systematic review in Anastomotic leak following colorectal surgery. C-reactive protein (CRP) and other inflammatory markers was evaluated on Prediction and early diagnosis of anastomotic leakage. Postoperative elevation of C-reactive protein is a reliable standard indicator for the early diagnosis of anastomotic leakage following colorectal surgery, with predictive value improving when combined with procalcitonin and clinical scores.
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