scholarly journals Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients

2022 ◽  
Vol 12 (1) ◽  
pp. 54
Author(s):  
Moran Slavin ◽  
Avigayil Goldstein ◽  
Barak Raguan ◽  
Yaron Rudnicki ◽  
Shmuel Avital ◽  
...  

Background: In colorectal cancer, C-reactive protein (CRP) levels on postoperative days 3–4 have a strong negative predictive value for an anastomotic leak, with threshold values of ~15 on post-operative day (POD) 3 and ~13 on POD 4. In Crohn’s disease, CRP levels are perceived as unreliable in the postoperative period because of the underlying inflammatory process. The aim of this study was to determine whether postoperative CRP levels can be used to rule out anastomotic leaks in patients with Crohn’s disease and to set CRP threshold values for this population. Methods: This was a retrospective study of a population of Crohn’s disease patients who underwent surgery with bowel anastomoses at a single high-volume center between 1/2012 and 12/2017. The operations were performed by a single colorectal consultant who is an inflammatory bowel disease specialist. Results: Ninety-two operations were performed. A CRP level of 19.56 mg/dL on postoperative day 3 had an area under the curve of 0.865 (sensitivity 88%, specificity 73%) and a negative predictive value (NPV) of 98% for an anastomotic leak. Patients with an anastomotic leak showed a trend towards decreased postoperative albumin levels (p = 0.06). Conclusions: Mean CRP levels and CRP threshold values were indeed higher in the study population compared with those in colorectal cancer patients. Threshold values were set at 20.3 mg/dL on POD 3, 19.5 mg/dL on POD 4 and 16.7 mg/dL on POD 5. These values had high NPVs and can be used to rule out anastomotic leaks in patients with Crohn’s disease after surgery with bowel anastomosis.

2021 ◽  
Author(s):  
Moran Slavin ◽  
Avygial Goldstein ◽  
Barak Raguan ◽  
Yaron Rudnicki ◽  
Shmuel Avital ◽  
...  

Abstract Background: In colorectal cancer, CRP levels on postoperative days 3-4 have a strong negative predictive value for an anastomotic leak, with threshold values of ~15 on POD 3 and ~13 on POD 4. In Crohn’s disease, CRP levels are perceived as unreliable in the postoperative period because of the underlying inflammatory process. The aim of this study was to investigate the use of postoperative CRP levels in patients with Crohn’s Disease and set threshold values for this population. Methods: This is a retrospective study of the medical records of adult patients with Crohn’s Disease who underwent bowel anastomoses, at a single, high volume center. The operations were performed by a single colorectal consultant who is an inflammatory bowel disease specialist, between 1/2012 and 12/2017. Results: 92 operations were performed. Mean CRP levels and CRP threshold values were higher in the study’s population compared with studies on colorectal cancer patients. A CRP level of 19.56 mg\dL on postoperative day 3 had an area under the curve of 0.865 (sensitivity 88%, specificity 73%) and a NPV of 98% for an anastomotic leak. Patients with an anastomotic leak showed a trend towards decreased postoperative albumin levels (p=0.06). Conclusions: Postoperative CRP values are higher in Crohn’s Disease compared with colorectal cancer. Postoperative CRP levels may rule out anastomotic leaks in patients with Crohn’s Disease with threshold values of 20.3 mg/dL in POD 3, 19.5 mg/dL in POD 4 and 16.7 mg\dL in POD 5.


BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier

Abstract Introduction The NUn score was created to try and predict the risk of anastomotic leak or major complications (using the Clavien- Dindo classification) from upper GI resections with an oesophageal anastomosis. A score of > 10 was used to predict an increased risk. In this study we attempt validation. Methods A database of 101 patients was studied, who underwent an Oesophagectomy for cancer between March 2017 and 2020. 72 patients had complete Post-operative day 4 bloods, needed to calculate the score. These patients were then studied for post-operative complications. Results A total of 12 patients had a NUn score of > 10 (16.67%). There was 1 death (1.37%) and 11 anastomotic leaks (15.28%). Of these the NUn score did not predict the death and predicted 8 of the 11 anastomotic leaks. From our data Conclusion From our analysis the NUNs score cannot be shown to be sensitive, specific or have useful positive predictive value. The average Nun score was not reliable, with confidence intervals crossing 10. There may be some merit in using the test for its negative predictive value, but further analysis into this is needed. The results of this audit are consistent with previous efforts at external validation.


2021 ◽  
Vol 10 (12) ◽  
pp. 2675
Author(s):  
Monika Zajkowska ◽  
Agnieszka Kulczyńska-Przybik ◽  
Maciej Dulewicz ◽  
Kamil Safiejko ◽  
Marcin Juchimiuk ◽  
...  

Colorectal cancer (CRC) is one of the most common malignancies. Despite the availability of diagnostic tests, an increasing number of new cases is observed. That is why it is very important to search new markers that would show high diagnostic utility. Therefore, we made an attempt to assess the usefulness of eotaxins, as there are few studies that investigate their significance, in patients with CRC. The study included 80 subjects (CRC patients and healthy volunteers). Serum concentrations of all eotaxins were measured using a multiplexing method (Luminex), while CCR3 was measured by immunoenzymatic assay (ELISA). CRP levels were determined by immunoturbidimetry and classical tumor marker levels (CEA and CA 19-9) and were measured using chemiluminescent microparticle immunoassay (CMIA). The highest usefulness among the proteins tested showed CCR3. Its concentrations were significantly higher in the CRC group than in healthy controls. The diagnostic sensitivity, specificity, positive and negative predictive value, and the area under the ROC curve (AUC) of CCR3 were higher than those of CA 19-9. The maximum values for sensitivity, negative predictive value, and AUC were obtained for a combination of CCR3 and CRP. Our findings suggest the potential usefulness of CCR3 in the diagnosis of CRC, especially in combination with CRP or CEA.


2011 ◽  
Vol 17 (suppl_1) ◽  
pp. S41-S41
Author(s):  
I Cardoso ◽  
G Santana ◽  
A Mello ◽  
S Leite ◽  
V Surlo ◽  
...  

2017 ◽  
Vol 37 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Sandra Cristina Dias dos Santos ◽  
Laura Elisabete Ribeiro Barbosa

2021 ◽  
Author(s):  
Kristyna Zarubova ◽  
Ondrej Fabian ◽  
Ondrej Hradsky ◽  
Tereza Lerchova ◽  
Filip Mikus ◽  
...  

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