Delta CRP (difference between CRP levels on POD3 and POD1) predicted anastomotic leak with an AUC of 0.969, specificity of 96.4%, and sensitivity of 92.3% in adults undergoing elective colorectal cancer surgery.
Prospective Cohort (n=320)
Yes
Does the trend of C-reactive protein (delta CRP) between postoperative days 1 and 3 improve the predictive value for anastomotic leak in patients undergoing colorectal surgery?
The trend of CRP between postoperative days 1 and 3 (delta CRP) is a highly sensitive and specific predictive marker for early detection of anastomotic leak after colorectal surgery.
Effect estimate: AUC 0.969 for delta CRP vs 0.692 for POD1 CRP
Absolute Event Rate: 0.969% vs 0.692%
Early diagnosis of anastomotic leak (AL) after colorectal surgery is essential to reduce mortality and overall survival. C-reactive protein (CRP) is among the factors most significantly associated with infection and AL. Analysis of trend in CRP levels could be crucial in increasing its predictive value. We performed a prospective evaluation on a cohort of patients undergoing colorectal resection for cancer, comparing CRP values on the first postoperative days to assess delta CRP in relation to identification of AL. Our prospective evaluation considered cases of elective colorectal surgery for cancer, enrolled by two high-volume centers from January 2021 to June 2024. We considered 2 groups: leakage (L group) and non-leakage (NL group). Evaluation of CRP levels on POD 1 and 3 was recorded, analyzing linear difference (delta CRP). Patients with suspicion of AL underwent postoperative imaging. Final analysis was conducted on 320 patients. Among these, 13 (4.1%) experienced an AL. CRP levels on POD1 and POD3, and delta CRP variables demonstrated AUC values of 0.692, 0.902, and 0.969, respectively, indicating that delta CRP is the most predictive measure compared to individual CRP values. Delta CRP reported a specificity of 0.964 and a sensitivity of 0.923. Our data confirmed that high NPV of postoperative CRP trend was able, already on POD3, to rule out anastomotic complications. CRP trend between POD1 and POD3 seems to increase the sensitivity and specificity of this biochemical marker, which should be confirmed by larger cohorts, considering this a pilot study.
Tramontano et al. (Thu,) conducted a prospective cohort in Adults undergoing elective colorectal surgery for cancer with primary anastomosis (n=320). Monitoring of C-reactive protein (CRP) levels and delta CRP (difference between POD1 and POD3 values) vs. Single CRP measurements at POD1 or POD3 was evaluated on Prediction of anastomotic leak (AL) after colorectal surgery using CRP values and delta CRP (AUC 0.969 for delta CRP vs 0.692 for POD1 CRP). Delta CRP (difference between CRP levels on POD3 and POD1) predicted anastomotic leak with an AUC of 0.969, specificity of 96.4%, and sensitivity of 92.3% in adults undergoing elective colorectal cancer surgery.