Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study
| Autor(a) principal: | |
|---|---|
| Data de Publicação: | 2022 |
| Outros Autores: | , , , , , , , , , , |
| Tipo de documento: | Artigo |
| Idioma: | eng |
| Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
| Texto Completo: | http://hdl.handle.net/10400.8/8690 |
Resumo: | Supported by the Ministry of Health – Incentive Program for the Integration of Care and Valuation of Patients’ Pathways in the National Health Service of Portugal. |
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Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational studyAnastomotic leakageColorectalSurgeryBiomarkersC-reactive proteinCalprotectinSupported by the Ministry of Health – Incentive Program for the Integration of Care and Valuation of Patients’ Pathways in the National Health Service of Portugal.BACKGROUND: Colorectal anastomotic leakage (CAL) is one of the most dreaded complications after colorectal surgery, with an incidence that can be as high as 27%. This event is associated with increased morbidity and mortality; therefore, its early diagnosis is crucial to reduce clinical consequences and costs. Some biomarkers have been suggested as laboratory tools for the diagnosis of CAL. AIM: To assess the usefulness of plasma C-reactive protein (CRP) and calprotectin (CLP) as early predictors of CAL. METHODS: A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis, from March 2017 to August 2019. Patients were divided into three groups: G1 – no complications; G2 – complications not related to CAL; and G3 – CAL. Five biomarkers were measured and analyzed in the first 5 postoperative days (PODs), namely white blood cell (WBC) count, eosinophil cell count (ECC), CRP, CLP, and procalcitonin (PCT). Clinical criteria, such as abdominal pain and clinical condition, were also assessed. The correlation between biomarkers and CAL was evaluated. Receiver operating characteristic (ROC) curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL, and the area under the ROC curve (AUROC), specificity, sensitivity, positive predictive value, and negative predictive value (NPV) during this period were estimated. RESULTS: In total, 25 of 396 patients developed CAL (6.3%), and the mean time for this diagnosis was 9.0 ± 6.8 d. Some operative characteristics, such as surgical approach, blood loss, intraoperative complications, and duration of the procedure, were notably related to the development of CAL. The length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications (median of 21 d vs 13 d and 7 d respectively; P < 0.001). For abdominal pain, the best predictive performance was on POD4 and POD5, with the largest AUROC of 0.84 on POD4. Worsening of the clinical condition was associated with the diagnosis of CAL, presenting a higher predictive effect on POD5, with an AUROC of 0.9. WBC and ECC showed better predictive effects on POD5 (AUROC = 0.62 and 0.7, respectively). Those markers also presented a high NPV (94%-98%). PCT had the best predictive effect on POD5 (AUROC = 0.61), although it presented low accuracy. However, this biomarker revealed a high NPV on POD3, POD4, and POD5 (96%, 95%, and 96%, respectively). The mean CRP value on POD5 was significantly higher in the group that developed CAL compared with the group without complications (195.5 ± 139.9 mg/L vs 59.5 ± 43.4 mg/L; P < 0.00001). On POD5, CRP had a NPV of 98%. The mean CLP value on POD3 was significantly higher in G3 compared with G1 (5.26 ± 3.58 μg/mL vs 11.52 ± 6.81 μg/mL; P < 0.00005). On POD3, the combination of CLP and CRP values showed a high diagnostic accuracy (AUROC = 0.82), providing a 5.2 d reduction in the time to CAL diagnosis. CONCLUSION: CRP and CLP are moderate predictors of CAL. However, the combination of these biomarkers presents an increased diagnostic accuracy, potentially decreasing the time to CAL diagnosis.Baishideng Publishing GroupIC-OnlineRama, Nuno J GLages, Marlene C CGuarino, Maria Pedro SLourenço, ÓscarMotta Lima, Patrícia CParente, DianaSilva, Cândida S GCastro, RicardoBento, AnaRocha, AnabelaCastro-Pocas, FernandoPimentel, João2023-07-25T17:14:35Z2022-06-282022-06-28T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.8/8690engRama NJG, Lages MCC, Guarino MPS, Lourenço Ó, Motta Lima PC, Parente D, Silva CSG, Castro R, Bento A, Rocha A, Castro-Pocas F, Pimentel J. Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study. World J Gastroenterol 2022; 28(24): 2758-2774 [PMID: 35979163 DOI: 10.3748/wjg.v28.i24.2758] Rama NJG, Lages MCC, Guarino MPS, Lourenço Ó, Motta Lima PC, Parente D, Silva CSG, Castro R, Bento A, Rocha A, Castro-Pocas F, Pimentel J. Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study. World J Gastroenterol 2022; 28(24): 2758-2774 [PMID: 35979163 DOI: 10.3748/wjg.v28.i24.2758]1007-932710.3748/wjg.v28.i24.27582219-2840926086435979163info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-01-17T15:57:55Zoai:iconline.ipleiria.pt:10400.8/8690Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T01:51:21.331414Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
| dc.title.none.fl_str_mv |
Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study |
| title |
Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study |
| spellingShingle |
Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study Rama, Nuno J G Anastomotic leakage Colorectal Surgery Biomarkers C-reactive protein Calprotectin |
| title_short |
Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study |
| title_full |
Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study |
| title_fullStr |
Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study |
| title_full_unstemmed |
Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study |
| title_sort |
Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study |
| author |
Rama, Nuno J G |
| author_facet |
Rama, Nuno J G Lages, Marlene C C Guarino, Maria Pedro S Lourenço, Óscar Motta Lima, Patrícia C Parente, Diana Silva, Cândida S G Castro, Ricardo Bento, Ana Rocha, Anabela Castro-Pocas, Fernando Pimentel, João |
| author_role |
author |
| author2 |
Lages, Marlene C C Guarino, Maria Pedro S Lourenço, Óscar Motta Lima, Patrícia C Parente, Diana Silva, Cândida S G Castro, Ricardo Bento, Ana Rocha, Anabela Castro-Pocas, Fernando Pimentel, João |
| author2_role |
author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
IC-Online |
| dc.contributor.author.fl_str_mv |
Rama, Nuno J G Lages, Marlene C C Guarino, Maria Pedro S Lourenço, Óscar Motta Lima, Patrícia C Parente, Diana Silva, Cândida S G Castro, Ricardo Bento, Ana Rocha, Anabela Castro-Pocas, Fernando Pimentel, João |
| dc.subject.por.fl_str_mv |
Anastomotic leakage Colorectal Surgery Biomarkers C-reactive protein Calprotectin |
| topic |
Anastomotic leakage Colorectal Surgery Biomarkers C-reactive protein Calprotectin |
| description |
Supported by the Ministry of Health – Incentive Program for the Integration of Care and Valuation of Patients’ Pathways in the National Health Service of Portugal. |
| publishDate |
2022 |
| dc.date.none.fl_str_mv |
2022-06-28 2022-06-28T00:00:00Z 2023-07-25T17:14:35Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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publishedVersion |
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http://hdl.handle.net/10400.8/8690 |
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http://hdl.handle.net/10400.8/8690 |
| dc.language.iso.fl_str_mv |
eng |
| language |
eng |
| dc.relation.none.fl_str_mv |
Rama NJG, Lages MCC, Guarino MPS, Lourenço Ó, Motta Lima PC, Parente D, Silva CSG, Castro R, Bento A, Rocha A, Castro-Pocas F, Pimentel J. Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study. World J Gastroenterol 2022; 28(24): 2758-2774 [PMID: 35979163 DOI: 10.3748/wjg.v28.i24.2758] Rama NJG, Lages MCC, Guarino MPS, Lourenço Ó, Motta Lima PC, Parente D, Silva CSG, Castro R, Bento A, Rocha A, Castro-Pocas F, Pimentel J. Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage: A prospective observational study. World J Gastroenterol 2022; 28(24): 2758-2774 [PMID: 35979163 DOI: 10.3748/wjg.v28.i24.2758] 1007-9327 10.3748/wjg.v28.i24.2758 2219-2840 9260864 35979163 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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Baishideng Publishing Group |
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Baishideng Publishing Group |
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reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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