CD 2014

Background

Anastomotic leakage is a frequent and life-threatening complication after colorectal surgery. Early recognition of anastomotic leakage is critical to reduce mortality. As early clinical and radiological signs of anastomotic leakage are often non-specific, there is an urgent need for accurate biomarkers. Markers of inflammation and gut damage may 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 (CRP), calprotectin, and IL-6; and intestinal damage markers intestinal fatty acid binding protein (I-FABP), liver fatty acid binding protein (L-FABP), and ileal bile acid binding protein (I-BABP) were measured. Diagnostic accuracy of single markers or combinations of markers was analyzed by ROC curve analysis.

Results

Eight patients developed anastomotic leakage, clinically diagnosed at median day 6. Calprotectin had best diagnostic accuracy to detect anastomotic leakage postoperatively. Highest diagnostic accuracy was obtained when CRP and calprotectin were combined at postoperative day (POD) 3, yielding sensitivity, 100%; specificity, 89%; LR+, 9.09 (95% CI, 4.34 - 16); and LR-, 0.00 (95% CI, 0.00 - 0.89); p<0.001. Interestingly, preoperative I-FABP levels predicted AL at a cut-off level of 882 pg/mL with sensitivity, 50%; specificity, 100%; LR+, infinite (95% CI, 4.01 - infinite); LR-, 0.50 (95% CI, 0.26 - 0.98); p<0.0001.

Conclusions

Preoperative I-FABP measurement may be used for anastomotic leakage risk assessment. Furthermore, combination of CRP and calprotectin has high diagnostic accuracy. Implementation of these markers in daily practice deserves further investigation.