Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery.

Abstract

BACKGROUND:

Several recent studies have investigated the role of C-reactive protein (CRP) as an early marker of anastomotic leakage following colorectal surgery. The aim of this systematic review and meta-analysis was to evaluate the predictive value of CRP in this setting.

METHODS:

A systematic literature search was performed using MEDLINE, Embase and PubMed to identify studies evaluating the diagnostic accuracy of postoperative CRP for anastomotic leakage following colorectal surgery. A meta-analysis was carried out using a random-effects model and pooled predictive parameters were determined along with a CRP cut-off value at each postoperative day (POD).

RESULTS:

Seven studies, with a total of 2483 patients, were included. The pooled prevalence of leakage was 9·6 per cent and the median day on which leakage was diagnosed ranged from POD 6 to 9. The serum CRP level on POD 3, 4 and 5 had comparable diagnostic accuracy for the development of an anastomotic leak with a pooled area under the curve of 0·81 (95 per cent confidence interval 0·75 to 0·86), 0·80 (0·74 to 0·86) and 0·80 (0·73 to 0·87) respectively. The derived CRP cut-off values were 172 mg/l on POD 3, 124 mg/l on POD 4 and 144 mg/l on POD 5; these corresponded to a negative predictive value of 97 per cent and a negative likelihood ratio of 0·26-0·33. All three time points had a low positive predictive value for leakage, ranging between 21 and 23 per cent.

CONCLUSION:

CRP is a useful negative predictive test for the development of anastomotic leakage following colorectal surgery.

• Authors: P P Singh, I S L Zeng, S Srinivasa, D P Lemanu, A B Connolly, A G Hill
• Journal: The British journal of surgery (Br J Surg) Vol. 101 Issue 4 Pg. 339-46 (Mar 2014) ISSN: 1365-2168 [Electronic] England
• PMID: 24311257 (Publication Type: Evaluation Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Chemical References

• Biomarkers
• C-Reactive Protein

Topics

• Anastomotic Leak (diagnosis)
• Biomarkers (metabolism)
• C-Reactive Protein (metabolism)
• Epidemiologic Methods
• Humans
• Postoperative Care
• Rectal Neoplasms (surgery)