The role of biomarkers in the early detection of dehiscence of intestinal and colonic anastomoses.

Abstract

Background: Anastomotic leakage is a major complication after intestinal and colorectal surgery. Diagnosis is usually established days after it has occurred, which is associated with high morbidity and mortality. Inflammatory markers have been proposed to predict the incidence of anastomotic leakage. Objective: The aim was to evaluate the role of C-reactive protein (CRP), white cell count, gamma-glutamyl transferase, CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR) and hyponatremia in early detection of anastomotic leakage (AL)in preclinical stage following open and laparoscopic colorectal and intestinal surgery. Patients and Methods: A longitudinal prospective cohort study included patients admitted to the general surgery department. Patients were indicated for intestinal anastomosis and were eligible for inclusion. Among them, 55 were on elective settings, and 50 in emergency settings. Results: A total of 105 patients were included. They had a mean age of 49.0±15.1 years and 61% of them were males. Twenty (19%) patients developed postoperative anastomotic leakage, among those, 6 were on the sixth postoperative day. CAR day 3 and CAR day 5 were significantly higher among the mortality patients with P values of 0.041 and 0.027, respectively. CRP level was significantly higher among patients with poor survival outcomes ( P value= 0.024 ). CRP trajectory was significantly associated with a mortality rate as patients who had a rise greater than 50 mg/dl between day 3 and day 5 had a higher mortality rate with a P value of 0.007. Conclusion: CRP trajectory, CAR and Neutrophil/lymphocyte ratio can significantly predict the incidence of anastomotic leakage. Settings of surgery (emergency) was an independent risk factor for development of postoperative leakage.