Objectives
Evaluation of the predictive value of serial estimations of serum presepsin (PSP), Creactive protein (CRP), and procalcitonin (PCT) for the development of infective
complications and/or anastomotic leakage (AL) after elective colorectal resection
with anastomosis for N0M0 colorectal cancers.
Patients and methods
During 7-year study period, 113 patients underwent colorectal resection;
postoperative (PO) morbidities were graded according to the comprehensive
complication index (CCI). Five venous blood samples (T1–5) were collected at the
time of induction of anesthesia, immediate, 1 day, 3 days, and 5 days after surgery for
blood leukocytic count, and calculation of neutrophil-to-lymphocyte ratio and
estimation of serum levels of the studied cytokines. Study outcome is the ability of
serum cytokines’ levels estimated in T2 sample to predict the possibility for the
development of AL.
Results
Incidence of PO infective morbidities was 31%, incidence of AL was 8.85%, and PO
mortality rate was 2.65%. Operative time was significantly longer; the total score of
the CCI was significantly higher and PO hospital stay was significantly longer for
patients who had AL. Patients who developed AL had significantly higher
neutrophil-to-lymphocyte ratio in T3–5 samples than in the T1 sample. Mean
serum levels of the studied cytokines were significantly higher in T2–5 samples
than in T1 sample with significantly higher levels in patients who developed AL.
Regression analysis defined high serum levels of PSP and PCT in the T3 sample
and CRP levels in T5 sample as predictors of AL and high levels of the three
biomarkers in the T3 sample could predict mortality. Automatic linear regression
defined high serum PSP levels in the T3 sample and long operative time as
significant predictors for high CCI and bad outcome with accuracy rates of 61
and 39%, respectively.
Conclusion
The level of serum biomarkers could predict AL, but PSP was superior to CRP and
PCT. High serum PSP levels in T2 sample can accurately predict high CCI for PO
complications. |
