Serum Procalcitonin Predicts Anastomotic Leaks in Colorectal Surgery

Firdaus Hayati, Zairul Azwan Mohd Azman, Dian Nasriana Nasuruddin, Luqman Mazlan, Andee Dzulkarnaen Zakaria, Ismail Sagap, Firdaus Hayati, Zairul Azwan Mohd Azman, Dian Nasriana Nasuruddin, Luqman Mazlan, Andee Dzulkarnaen Zakaria, Ismail Sagap

Abstract

Background: Anastomotic leaks in colorectal surgery results in a high morbidity and mortality rate. Serum procalcitonin levels is known as a sensitive and specific marker of sepsis and could be use as a marker for early detection of a leak allowing early intervention. It may help a clinician decide to perform a CT scan even earlier especially when the diagnosis of a leak is uncertain. The aim of this study is to determine whether serum procalcitonin is a good predictor of anastomotic leak in colorectal surgery. Methodology: Between July 2014 until October 2015, 70 patients undergoing colorectal surgery were prospectively analyzed in a single-center tertiary teaching hospital. Demographic and surgical data were obtained. Serum procalcitonin was taken before surgery and at day 3 (72 hours) postoperatively. During the postoperative period, the patients were observed in the ward for features of anastomotic leak and if present, it was managed accordingly. The primary outcome was to prospectively determine an association between serum procalcitonin levels and an anastomotic leak in patients who underwent colorectal surgery with a primary anastomosis. Result: The rate of anastomotic leak was 4.5% (3 patients) with a mortality rate of 4.3% (3 patients). A rise in serum procalcitonin was statistically significant among patients with anastomotic leak. The optimal procalcitonin cut-off level at postoperative day 3 was 5.27 ng/mL, resulting in 100% sensitivity, 85% specificity, 23% positive predictive value and 100% negative predictive value. Nevertheless, none of the variables showed statistical significance with an anastomotic leak. Conclusion: Procalcitonin is a reliable biochemical marker to help diagnose anastomotic leak in colorectal surgery. Our study has shown that a level of 5 times beyond normal is statistically significant and a value of more than 5.27 ng/mL is confirmatory of a leak.

Keywords: Colon; leak; procalcitonin; rectum; surgery.

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Figures

Figure 1
Figure 1
ROC Curve for PCT at Day 3
Figure 2
Figure 2
ROC Curve for TWC at Day 3

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