Procalcitonin as a Biomarker for Detecting Anastomotic Leak Following Elective Colectomy

Early diagnosis of anastomotic leak (AL) following elective colonic resection remains challenging. Procalcitonin has emerged as a potential biomarker for AL. This study aimed to evaluate the utility of procalcitonin in detecting AL following elective colectomy in our patient cohort.

A prospective observational study was conducted across four hospitals in New Zealand over 3 y. Preoperative and postoperative days (PODs) 1-five blood samples were collected from participants undergoing elective colectomy. Procalcitonin levels were compared between participants with and without AL using statistical analyses.

Median procalcitonin levels were consistently higher in the AL group than the no-AL group, but this difference was only significant on POD 3 (0.489 ng/mL versus 0.286 ng/mL; P = 0.047). Multivariable regression analyses did not demonstrate an association between POD 1-5 procalcitonin levels and AL, when adjusted for approach and Surgical Site Infection. Receiver operating characteristic curves did not achieve an area under the curve above 0.7 at any of the six measured time periods. When the AL group was divided into early (≤ POD 6) and late AL (> POD 6) and compared to the no-AL group, a significant difference was observed on POD 3 (1.571 ng/mL versus 0.321 ng/mL versus 0.206 ng/mL; P = 0.028).

Procalcitonin levels were only significantly elevated in the AL group on POD 3 using univariate analysis. A significant difference was observed when the AL group was divided into early AL and late AL and compared to the no-AL group. Procalcitonin does not appear to be independently useful in detection of AL following elective colonic resection.