Skip to main content Skip to main navigation menu Skip to site footer

C-reactive protein levels as a predictor for anastomotic success in post-operative intestinal resection surgery



Abstract

Background: C-reactive protein (CRP) is widely used as an early predictor of anastomotic complications such as anastomotic leakage (AL) after abdominal surgery. There are no data available regarding the AL in A.W.Sjahranie Regional General Hospital (RSUD AWS). This study analyzed the CRP values and their relationship with AL after bowel resection and anastomosis surgery at RSUD AWS Samarinda.

Methods: This is an observational analytic cross-sectional study. Sample data were collected from the medical records of 40 patients who underwent bowel resection between May and December 2019. Patients were between 18-75 years old and showed clinical signs of AL. CRP laboratory data were examined on the fifth-day post-operation. After tabulation, the data were analyzed using Chi-square (Fisher’s exact) test, t-test, and receiver operating characteristic curve analysis.

Results: The average sample age was 46.3 ± 1.31 years, with a 1:1 male and female ratio. The analysis showed that an increase in CRP values and white blood cell counts was not related to AL (p > 0.05). The mean CRP value of patients with AL (48.0±0.00 mg/L) was not significantly different if compared to non-AL patients (25.89 ± 18.93 mg/L) (p = 0.139). The CRP cut-off value of 36 mg/L had 100% sensitivity, 60.5% specificity, 71.7% positive predictive value and 100% negative predictive value with an area under the curve of 0.80 (p=0.153). These results showed that the CRP cut-off value of 36 mg/L couldn't be used as a predictor of AL.

Conclusion: CRP level of 36 mg/L can be used as a predictor of non-AL; therefore, it can be used as a criterion for patient discharge.

Keywords: Anastomotic leakage bowel resection CRP

References

  1. Liang MK, Andersson RE, Jaffe BM, et al. The Appendix. In: Brunicardi FC, Andersen DK, Billiar TR, et al. editors. Schwartz’s principles of surgery. 10th ed. New York: McGraw-Hill Education; 2015:1241-57.
  2. Goulder F. Bowel anastomoses: The theory, the practice and the evidence base. World J Gastrointest Surg. 2012;4(9):208.
  3. Davis B, Rivadeneira DE. Complications of colorectal anastomoses. Surg Clin North Am. 2013;93(1):61–87.
  4. Zawadzki M, Czarnecki R, Rzaca M, et al. C-reactive protein and procalcitonin predict anastomotic leaks following colorectal cancer resections – a prospective study. Videosurg Miniinv Techniques. 2016;10:567–73.
  5. Schiff A, Roy S, Pignot M, et al. Diagnosis and management of intraoperative colorectal anastomotic leaks: A global retrospective patient chart review study. Surg Res Pract. 2017;1–9.
  6. Blumetti J. Management of low colorectal anastomotic leak: Preserving the anastomosis. World J Gastrointest Surg. 2015;7(12):378.
  7. Garcia-Granero A, Frasson M, Flor-Lorente B, et al. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery. Dis Colon Rectum. 2013;56(4):475–83.
  8. Almeida AB, Faria G, Moreira H, et al. Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery. Int J Surg. 2012;10(2):87–91.
  9. Singh PP, Zeng IS, Srinivasa S, et al. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101(4):339–46.
  10. Reynolds IS, Boland MR, Reilly F, et al. C-reactive protein as a predictor of anastomotic leak in the first week after anterior resection for rectal cancer. Colorectal Dis. 2017;19(9):812–18.
  11. Chandra BJS, Kumar S, Girish S. Evaluation of C-reactive protein as an early predictor of septic complications after elective colorectal surgery. Int J Appl Res. 2015;1:28-37.
  12. Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surgeons. 2009;208(2):269-78.
  13. Pommergaard HC, Gessler B, Burcharth J. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis. 2014;16(9):662-71.
  14. Benedetti M, Ciano P, Pergolini I, et al. Early diagnosis of anastomotic leakage after colorectal surgery by the Dutch leakage score, serum procalcitonin and serum C-reactive protein: study protocol of a prospective multicenter observational study by the Italian ColoRectal Anastomotic Leakage. Il Giornale de Chirurgia. 2019;40(1):20-5.
  15. Welsch T, Muller SA, Ulrich A, et al. C-reactive protein as early predictor for infectious post-operative complications in rectal surgery. Int J Colorectal Dis. 2007;22(12):1499-1507.
  16. Ortega-Deballon P, Radais F, Facy O, et al. C-reactive protein is an early predictor of septic complications after elective colorectal surgery. World J Surg. 2010;34(4):808-14.
  17. Purnamaningsih SM. Serum markers of Inflammatory Bowel Disease: A literature review. Bali Med J. 2018;7(2):491-499
  18. Mackay GJ, Molloy RG, O’Dwyer PJ. C-reactive protein as a predictor of post-operative infective complications following elective colorectal resection. Colorectal Dis. 2011;13(5):583–87.
  19. Warschkow R, Beutner U, Steffen T, et al. Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1832 patients. Ann Surg. 2012;256(2):245-50.
  20. Platt J, Ramanathan M, Crosbie R, et al. C-reactive protein as a predictor of post-operative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19(13):4168–77.
  21. Muñoz JL, Alvarez MO, Cuquerella V, et al. Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program. Surg Endosc. 2018;32(9):4003–10.

How to Cite

Basuki, I., Kusuma, M. I., Suprapto, B., & Hendarto, J. (2020). C-reactive protein levels as a predictor for anastomotic success in post-operative intestinal resection surgery. Bali Medical Journal, 9(2), 511–515. https://doi.org/10.15562/bmj.v9i2.1848
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
1

Total
15

Share

Search Panel

Isa Basuki
Google Scholar
Pubmed
BMJ Journal

Muhammad Ihwan Kusuma
Google Scholar
Pubmed
BMJ Journal

Bambang Suprapto
Google Scholar
Pubmed
BMJ Journal

Joko Hendarto
Google Scholar
Pubmed
BMJ Journal