C-reactive protein in drainage fluid as a predictor of anastomotic leakage after elective colorectal resection

Zoran Kostić; Damjan Z Slavković; Zoran Mijušković; Marina Panišić; Mile Ignjatović

doi:10.2298/7045

Zoran Kostić Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Damjan Z Slavković Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
Zoran Mijušković Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Marina Panišić Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
Mile Ignjatović Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/7045

Keywords: c-reactive protein, prognosis, surgical wound dehiscence, surgical procedures, operative, colorectal neoplasms,

Abstract

Background/Aim. C-reactive protein (CRP) is considered to be an indicator of postoperative complications in abdominal surgery. The aim of this study was to determine the significance of serial measurement of CRP in drainage fluid in the detection of anastomotic leakage (AL) in patients with colorectal resection. Methods. CRP 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 groups of patient without complications of surgical treatment and those with AL. Results. Clinically evident AL was observed in 15 patients – in two (4.2%) patients with left colonic surgery, and 13 (12.6%) patients with colorectal anastomosis. Mean values of CRP were higher in the patients with AL than in the patients without complications, both in serum and drainage fluid, with the most significant differences recorded on the PODs 5 and 7 (p < 0.001). Correlation analysis showed a positive correlation between serum and drainage fluid CRP levels in both groups of patients. Serum and drainage fluid CRP values on the PODs 5 and 7 are most important in the detection of AL. In 80% of patients with CRP values in the drainage fluid of 53 mg/L for the POD 5 and 42 mg/L for the POD 7 AL was observed. The method specificity was 77% for the POD 5, and 83% for the POD 7. All the patients with CRP values in drainage fluid above 108 mg/L on the POD 5 and 93 mg/L on the POD 7 had AL. Conclusion. Serial measurement of CRP in drainage fluid can reliably be used in the detection of AL in patients with colorectal resection. The most significant values obtained on the PODs 5 and 7 were positively correlated with the values registered in serum.

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