Kostan W Reisinger1, Martijn Poeze2, Karel W E Hulsewé3, Bernadette A van Acker4, Annemarie A van Bijnen2, Anton G M Hoofwijk3, Jan H M B Stoot3, Joep P M Derikx5. 1. Department of Surgery, Maastricht University Medical Center and Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands. Electronic address: k.reisinger@maastrichtuniversity.nl. 2. Department of Surgery, Maastricht University Medical Center and Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands. 3. Department of Surgery, Orbis Medical Center, Sittard, The Netherlands. 4. Department of Clinical Chemistry, Orbis Medical Center, Sittard, The Netherlands. 5. Department of Surgery, Maastricht University Medical Center and Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Surgery, Orbis Medical Center, Sittard, The Netherlands.
Abstract
BACKGROUND: Anastomotic leakage is a frequent and life-threatening complication after colorectal surgery. Early recognition of anastomotic leakage is critical to reduce mortality. Because early clinical and radiologic signs of anastomotic leakage are often nonspecific, there is an urgent need for accurate biomarkers. Markers of inflammation and gut damage might be suitable, as these are hallmarks of anastomotic leakage. STUDY DESIGN: In 84 patients undergoing scheduled colorectal surgery with primary anastomosis, plasma samples were collected preoperatively and daily after surgery. Inflammatory markers, C-reactive protein; calprotectin; and interleukin-6, and intestinal damage markers, intestinal fatty acid binding protein; liver fatty acid binding protein; and ileal bile acid binding protein, were measured. Diagnostic accuracy of single markers or combinations of markers was analyzed by receiver operating characteristic curve analysis. RESULTS: Anastomotic leakage developed in 8 patients, clinically diagnosed at median day 6. Calprotectin had best diagnostic accuracy to detect anastomotic leakage postoperatively. Highest diagnostic accuracy was obtained when C-reactive protein and calprotectin were combined at postoperative day 3, yielding sensitivity of 100%, specificity of 89%, positive likelihood ratio = 9.09 (95% CI, 4.34-16), and negative likelihood ratio = 0.00 (95% CI, 0.00-0.89) (p < 0.001). Interestingly, preoperative intestinal fatty acid binding protein levels predicted anastomotic leakage at a cutoff level of 882 pg/mL with sensitivity of 50%, specificity of 100%, positive likelihood ratio = infinite (95% CI, 4.01-infinite), and negative likelihood ratio = 0.50 (95% CI, 0.26-0.98) (p < 0.0001). CONCLUSIONS: Preoperative intestinal fatty acid binding protein measurement can be used for anastomotic leakage risk assessment. In addition, the combination of C-reactive protein and calprotectin has high diagnostic accuracy. Implementation of these markers in daily practice deserves additional investigation.
BACKGROUND:Anastomotic leakage is a frequent and life-threatening complication after colorectal surgery. Early recognition of anastomotic leakage is critical to reduce mortality. Because early clinical and radiologic signs of anastomotic leakage are often nonspecific, there is an urgent need for accurate biomarkers. Markers of inflammation and gut damage might be suitable, as these are hallmarks of anastomotic leakage. STUDY DESIGN: In 84 patients undergoing scheduled colorectal surgery with primary anastomosis, plasma samples were collected preoperatively and daily after surgery. Inflammatory markers, C-reactive protein; calprotectin; and interleukin-6, and intestinal damage markers, intestinal fatty acid binding protein; liver fatty acid binding protein; and ileal bile acid binding protein, were measured. Diagnostic accuracy of single markers or combinations of markers was analyzed by receiver operating characteristic curve analysis. RESULTS:Anastomotic leakage developed in 8 patients, clinically diagnosed at median day 6. Calprotectin had best diagnostic accuracy to detect anastomotic leakage postoperatively. Highest diagnostic accuracy was obtained when C-reactive protein and calprotectin were combined at postoperative day 3, yielding sensitivity of 100%, specificity of 89%, positive likelihood ratio = 9.09 (95% CI, 4.34-16), and negative likelihood ratio = 0.00 (95% CI, 0.00-0.89) (p < 0.001). Interestingly, preoperative intestinal fatty acid binding protein levels predicted anastomotic leakage at a cutoff level of 882 pg/mL with sensitivity of 50%, specificity of 100%, positive likelihood ratio = infinite (95% CI, 4.01-infinite), and negative likelihood ratio = 0.50 (95% CI, 0.26-0.98) (p < 0.0001). CONCLUSIONS: Preoperative intestinal fatty acid binding protein measurement can be used for anastomotic leakage risk assessment. In addition, the combination of C-reactive protein and calprotectin has high diagnostic accuracy. Implementation of these markers in daily practice deserves additional investigation.
Authors: V D Plat; J P M Derikx; A C Jongen; K Nielsen; D J A Sonneveld; J J C Tersteeg; R M P H Crolla; D A van Dam; H A Cense; T G J de Meij; J B Tuynman; N K H de Boer; F Daams Journal: Tech Coloproctol Date: 2020-02-27 Impact factor: 3.781
Authors: José Luis Muñoz; María Oliva Alvarez; Vicent Cuquerella; Elena Miranda; Carlos Picó; Raquel Flores; Marta Resalt-Pereira; Pedro Moya; Ana Pérez; Antonio Arroyo Journal: Surg Endosc Date: 2018-03-08 Impact factor: 4.584
Authors: Nuno J G Rama; Marlene C C Lages; Maria Pedro S Guarino; Óscar Lourenço; Patrícia C Motta Lima; Diana Parente; Cândida S G Silva; Ricardo Castro; Ana Bento; Anabela Rocha; Fernando Castro-Pocas; João Pimentel Journal: World J Gastroenterol Date: 2022-06-28 Impact factor: 5.374
Authors: Cloë L Sparreboom; Zhouqiao Wu; Adem Dereci; Geesien S A Boersema; Anand G Menon; Jiafu Ji; Gert-Jan Kleinrensink; Johan F Lange Journal: Gastroenterol Res Pract Date: 2016-03-09 Impact factor: 2.260
Authors: Audrey Chm Jongen; Joanna Wam Bosmans; Serdar Kartal; Tim Lubbers; Meindert Sosef; Gerrit D Slooter; Jan H Stoot; Frederik-Jan van Schooten; Nicole D Bouvy; Joep Pm Derikx Journal: JMIR Res Protoc Date: 2016-06-09