Diagnostic value of serial measurement of C-reactive protein in serum and matrix metalloproteinase-9 in drainage fluid in the detection of infectious complications and anastomotic leakage in patients with colorectal resection
Abstract
Background/Aim. Postoperative infectious complications are
one of the most important problems in surgical treatment of colorectal
cancer (CRC), being present in up to 40% of patients.
The aim of this paper was to establish the significance of serial
measurement of C-reactive protein (CRP) in serum and matrix
metalloproteinase-9 (MMP-9) in drainage fluid for the detection
of infectious complications and anastomotic leakage (AL) in patients
with colorectal resection. Methods. CRP and MMP-9 values
in serum and drainage fluid, respectively, were measured on
the first, third, fifth, and seventh postoperative day (POD) in 150
patients with colorectal resection and primary anastomosis. The
values obtained were compared between the patients without
complicatons and those with surgical site and remote infections
and AL. Results. Surgical site infections (SSIs) were observed in
41 (27.3%), and remote infections in 10 (6.7%) patients. Clinically
evident AL was observed in 15 (10%) patients. In 82% of
the patients with SSIs, serum CRP value on POD 5 exceeded 82
mg/L, with 81% specificity. AL was reported in 85% and 92%
of the patients on PODs 5 and 7, respectively, with CRP values
of 77 mg/L and 90 mg/L, respectively. The specificity was 77%
for POD 5 and 88% for POD 7. All the patients with CRP values
exceeding 139 mg/L on POD 5 had some of SSIs and/or
AL. The mean values of MMP-9 were not statistically different
between the group without complications (n = 99) and the group
with AL (n = 15). Conclusion. Serial measurement of CRP is
recommended for screening of infectious complications of colorectal
resection. Patients with CRP values above 139 mg/L on
POD 5 cannot be discharged from hospital, and require an intensive
search for infectious complications, particularly AL.
MMP-9 measurement in drainage fluid is not relevant in the detection
of AL in patients with colorectal resection.
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