Dost Wahidullah, Rasully Mohammad Qaher, Zaman Mohammad Nazir, Dost Wahida, Ali Wahida, Ayobi Sami A, Dost Raisa, Niazi Jamaluddin, Bakht Kinza, Iqbal Asma, Bokhari Syed Faqeer Hussain
Surgery/Medicine, Kabul University of Medical Sciences, Kabul, AFG.
General Surgery, Jamhuriat Hospital, Kabul, AFG.
Cureus. 2024 Nov 27;16(11):e74616. doi: 10.7759/cureus.74616. eCollection 2024 Nov.
Anastomotic leaks (ALs) remain a serious postoperative complication in colorectal surgery, often resulting in significant morbidity, prolonged hospitalization, and increased mortality risk. This systematic review aims to evaluate the role of predictive biomarkers in the early detection of ALs, focusing on their diagnostic accuracy and clinical utility. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted across MEDLINE, Scopus, CENTRAL, and Web of Science, identifying studies that examined biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), and white blood cell (WBC) count in the context of AL. A total of 20 studies met the inclusion criteria, with sample sizes ranging from 59 to 2,655 patients undergoing colorectal surgeries with primary anastomosis. CRP emerged as the most widely studied and reliable biomarker, with studies suggesting that elevated CRP levels, particularly on postoperative days 3-4, can effectively indicate AL risk, showing high negative predictive value. PCT has also shown promise as a complementary biomarker, offering enhanced specificity for infectious complications. Although WBC count alone was a limited predictor, it may add diagnostic value when used with other markers. In addition, innovative biomarkers, such as inflammatory indices in peritoneal fluid, demonstrated potential for further improving AL detection accuracy.
吻合口漏（ALs）仍是结直肠手术中一种严重的术后并发症，常导致显著的发病率、延长住院时间以及增加死亡风险。本系统评价旨在评估预测性生物标志物在早期检测ALs中的作用，重点关注其诊断准确性和临床实用性。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，在MEDLINE、Scopus、CENTRAL和科学网进行了全面的文献检索，确定了在AL背景下研究C反应蛋白（CRP）、降钙素原（PCT）和白细胞（WBC）计数等生物标志物的研究。共有20项研究符合纳入标准，样本量从59例到2655例接受一期吻合结直肠手术的患者不等。CRP是研究最广泛且可靠的生物标志物，研究表明CRP水平升高，尤其是在术后第3至4天，可有效提示AL风险，具有较高的阴性预测价值。PCT也显示出作为补充生物标志物的前景，对感染性并发症具有更高的特异性。虽然单独的WBC计数预测能力有限，但与其他标志物联合使用时可能会增加诊断价值。此外，诸如腹水中炎症指标等创新性生物标志物在进一步提高AL检测准确性方面显示出潜力。
