Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage - 14/08/14
, Juliette Slieker, M.D. a, Paul Willemsen, M.D. b, Guido Mannaerts, M.D., Ph.D. c, Piet Pattyn, M.D., Ph.D. d, Tom Karsten, M.D., Ph.D. e, Hans de Wilt, M.D., Ph.D. a, f, Erwin van der Harst, M.D, Ph.D. g, Yolanda B. de Rijke, Ph.D. h, Magdalena Murawska, Ph.D. i, Johannes Jeekel, M.D., Ph.D. a, Johan F. Lange, M.D., Ph.D. aThe APPEAL Study Group
Abstract |
Background |
We aim to determine if C-reactive protein (CRP), lipopolysaccharide-binding protein (LBP), and procalcitonin (PCT) in drain fluid can serve as screening tools for colorectal anastomotic leakage (CAL).
Methods |
Patients included in this multicenter prospective observational study underwent left hemicolectomy, sigmoid resection, high anterior resection, low anterior resection, or subtotal colectomy. During the first 5 postoperative days, CRP, LBP, and PCT were determined on drain fluid.
Results |
In total 243 patients were included, of whom 19 (8%) developed CAL. CRP levels were higher in patients with leakage on day 3 and day 5, levels of LBP were higher on days 2, 3, and 4, and PCT levels were higher on day 5. Multivariate analysis showed LBP to be significantly related to CAL. An increase in the average initial value at the first postoperative day with 1 standard deviation increased the risk of leakage by 1.6 times.
Conclusion |
Increased concentrations of LBP in drain fluid are significantly associated to a higher chance of CAL and could contribute in a future prognostic model for CAL.
Le texte complet de cet article est disponible en PDF.Keywords : Anastomotic leakage, Lipopolysaccharide-binding protein, CRP, Procalcitonin, Colorectal surgery, Screening
Plan
| This research was made possible by grant from “Stichting Technische Wetenschappen” (STW), Utrecht, The Netherlands. STW had no role in the study design, in collection, analysis and interpretation of the data, in writing of this manuscript or in the decision to submit. |
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| Supported by grant from “Stichting Technische Wetenschappen,” Utrecht, The Netherlands. |
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| The authors declare no conflicts of interest. |
Vol 208 - N° 3
P. 317-323 - septembre 2014 Retour au numéro
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