C-reactive protein trajectory to predict colorectal anastomotic leak: PREDICT Study

Area of Science:

• Colorectal Surgery
• Surgical Complications
• Biomarker Discovery

Background:

• Anastomotic leak is a frequent complication of colorectal surgery, increasing morbidity, mortality, and reducing long-term survival.
• Early detection of anastomotic leaks is crucial for improving short-term outcomes and potentially reducing cancer recurrence.
• Previous research indicated C-reactive protein (CRP) trajectory is a strong predictor of anastomotic leaks requiring intervention.

Purpose of the Study:

• To externally validate the predictive value of C-reactive protein (CRP) levels for diagnosing anastomotic leaks after colorectal surgery.
• To assess the accuracy of CRP trajectory in identifying patients with anastomotic leaks requiring intervention.
• To confirm the utility of CRP as a biomarker for early anastomotic leak detection.

Main Methods:

• Prospective international multicenter observational study involving adults undergoing elective colorectal resection.
• Measurement of C-reactive protein (CRP) levels preoperatively and for five days postoperatively.
• Primary outcome was defined as an anastomotic leak requiring operative or radiological intervention.

Main Results:

• Out of 833 patients analyzed, 4.9% developed an anastomotic leak.
• A CRP level change exceeding 50 mg/l between postoperative days demonstrated 85% sensitivity for leak detection and 99% negative predictive value.
• A CRP change >50 mg/l between postoperative days 3-4 or 4-5 showed 96-97% specificity and positive likelihood ratios of 4.99-6.44 for leaks requiring intervention.

Conclusions:

• The study validates the significant value of monitoring C-reactive protein (CRP) levels' trajectory.
• CRP monitoring accurately rules out anastomotic leaks following colorectal resection.
• This biomarker approach aids in the early and reliable diagnosis of anastomotic leaks.