Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery  

Oleh:

Singh, P. P. ; Zeng, I. S. L. ; Srinivasa, S. ; Lemanu, D. P. ; Connolly, A. B. ; Hill, A. G.

Jenis: Article from Article - diterbitkan di jurnal ilmiah internasional
Dalam koleksi: BJS: British Journal of Surgery vol. 101 no. 04 (Mar. 2014), page 339-346.

Ketersediaan

Perpustakaan FK Nomor Panggil: B15.K.2014.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background Several recent studies have investigated the role of C-reactive protein (CRP) as an early marker of anastomotic leakage following colorectal surgery. The aim of this systematic review and meta-analysis was to evaluate the predictive value of CRP in this setting. Methods A systematic literature search was performed using MEDLINE, Embase and PubMed to identify studies evaluating the diagnostic accuracy of postoperative CRP for anastomotic leakage following colorectal surgery. A meta-analysis was carried out using a random-effects model and pooled predictive parameters were determined along with a CRP cut-off value at each postoperative day (POD). Results Seven studies, with a total of 2483 patients, were included. The pooled prevalence of leakage was 9·6 per cent and the median day on which leakage was diagnosed ranged from POD 6 to 9. The serum CRP level on POD 3, 4 and 5 had comparable diagnostic accuracy for the development of an anastomotic leak with a pooled area under the curve of 0·81 (95 per cent confidence interval 0·75 to 0·86), 0·80 (0·74 to 0·86) and 0·80 (0·73 to 0·87) respectively. The derived CRP cut-off values were 172?mg/l on POD 3, 124?mg/l on POD 4 and 144?mg/l on POD 5; these corresponded to a negative predictive value of 97 per cent and a negative likelihood ratio of 0·26–0·33. All three time points had a low positive predictive value for leakage, ranging between 21 and 23 per cent. Conclusion CRP is a useful negative predictive test for the development of anastomotic leakage following colorectal surgery.

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