Cananzi Ferdinando Carlo Maria, Biondi Alberto, Agnes Annamaria, Ruspi Laura, Sicoli Federico, De Pascale Stefano, Fumagalli Uberto Romario, D'Ugo Domenico, Quagliuolo Vittorio, Persiani Roberto
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, MI, Italy.
Sarcoma and Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy.
J Gastrointest Surg. 2023 Mar;27(3):478-488. doi: 10.1007/s11605-022-05547-y. Epub 2022 Dec 12.
The aim of this study was to define whether procalcitonin (PCT) is an earlier and more accurate predictor than C-reactive protein (CRP) for anastomotic leakage (AL) and major infective complications (MICs).
This was a prospective multicentric observational study conducted in three Italian centers, including all patients undergoing gastrectomy from May 2016 to April 2021. The endpoint was the assessment of the discrimination and accuracy achieved by the PCT and CRP values measured from POD1 to POD7 for predicting the occurrence of AL and MICs. Accuracy was assessed by calculating the area under the receiver operating curve (AUROC) values and Youden's statistics. Two charts were created for risk stratification during the postoperative course.
The rate of AL was 4.6%, with a median day of occurrence on POD5 (range 3-26). The overall rate of major infective complications was 19.9%, with a median day of occurrence on POD6 (range 2-30). PCT showed a significant association with AL on POD6 and POD7 and a significant association with MICs on POD2, while CRP values showed a significant association with AL on POD4 and a significant association with MICs on POD1. No difference in the prediction of AL was observed between PCT and CRP, while CRP was found to be a superior predictor of major infective complications on POD5 (p = 0.024) and POD7 (p = 0.035).
PCT was not superior to CRP as an early predictor of AL and major infective complications after gastrectomy. CRP should be used as the reference screening postoperative marker.
本研究的目的是确定降钙素原（PCT）对于吻合口漏（AL）和主要感染性并发症（MICs）的预测是否比C反应蛋白（CRP）更早且更准确。
这是一项在三个意大利中心进行的前瞻性多中心观察性研究，纳入了2016年5月至2021年4月期间所有接受胃切除术的患者。终点是评估从术后第1天（POD1）至第7天（POD7）测量的PCT和CRP值在预测AL和MICs发生方面的鉴别能力和准确性。通过计算受试者工作特征曲线下面积（AUROC）值和尤登指数来评估准确性。绘制了两张图表用于术后过程中的风险分层。
AL发生率为4.6%，中位发生时间为POD5（范围3 - 26天）。主要感染性并发症的总体发生率为19.9%，中位发生时间为POD6（范围2 - 30天）。PCT在POD6和POD7时与AL显著相关，在POD2时与MICs显著相关，而CRP值在POD4时与AL显著相关，在POD1时与MICs显著相关。在预测AL方面，PCT和CRP之间未观察到差异，而发现CRP在POD5（p = 0.024）和POD7（p = 0.035）时是主要感染性并发症的更好预测指标。
在胃切除术后，PCT作为AL和主要感染性并发症的早期预测指标并不优于CRP。CRP应作为术后参考筛查标志物。
