Hayati Firdaus, Mohd Azman Zairul Azwan, Nasuruddin Dian Nasriana, Mazlan Luqman, Zakaria Andee Dzulkarnaen, Sagap Ismail
Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, Malaysia. Email:
Asian Pac J Cancer Prev. 2017 Jul 27;18(7):1821-1825. doi: 10.22034/APJCP.2017.18.7.1821.
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.
结直肠手术中的吻合口漏会导致高发病率和死亡率。血清降钙素原水平是脓毒症的敏感且特异标志物，可作为早期检测吻合口漏的标志物，从而实现早期干预。这可能有助于临床医生更早地决定进行CT扫描，尤其是在吻合口漏的诊断不确定时。本研究的目的是确定血清降钙素原是否是结直肠手术中吻合口漏的良好预测指标。方法：2014年7月至2015年10月，在一家单中心三级教学医院对70例接受结直肠手术的患者进行了前瞻性分析。获取了人口统计学和手术数据。术前及术后第3天（72小时）采集血清降钙素原。术后期间，在病房观察患者有无吻合口漏的特征，如有则进行相应处理。主要结局是前瞻性确定接受一期吻合的结直肠手术患者血清降钙素原水平与吻合口漏之间的关联。结果：吻合口漏发生率为4.5%（3例患者），死亡率为4.3%（3例患者）。吻合口漏患者血清降钙素原升高具有统计学意义。术后第3天降钙素原的最佳截断水平为5.27 ng/mL，敏感性为100%，特异性为85%，阳性预测值为23%，阴性预测值为100%。然而，没有一个变量与吻合口漏具有统计学意义。结论：降钙素原是帮助诊断结直肠手术中吻合口漏的可靠生化标志物。我们的研究表明，超过正常水平5倍具有统计学意义，超过5.27 ng/mL的值可确诊吻合口漏。
