Post-operative C-Reactive Protein trend may lead to early diagnosis of anastomotic leak after ileocolic resection in Crohn’s disease

Abstract

Abstract Purpose: C-Reactive Protein is a useful biomarker commonly used during post-operative care for patients having undergone colorectal cancer surgery and aid clinicians in the early detection of anastomotic leak. We aim to analyse this marker’s trend among patients with Crohn’s disease having undergone an ileocolic resection with primary anastomosis to detect an anastomotic leak. Methods: We included in this retrospective study all patients having undergone ileocolic resection with primary anastomosis. C-Reactive Protein was measured during the first 48 hours and repeated 48 hours thereafter. Variation between these two measurements was analysed. The main endpoint was the discovery or not of an anastomotic leak by Computed Tomography imaging in relation to the variation of the C-Reactive Protein between the two measurements. Secondary endpoint was the discovery of an anastomotic leak needing an immediate operative approach. Results: 59 patients were included. Eight patients (13.5%) suffered from an anastomotic leak. Four (6.7%) patients needed urgent surgical care. The variation of the C-Reactive Protein between the two measurements with a cut-off of 1.37% allowed for a sensitivity of 87.5% and a specificity of 72.5%. Positive predictive value was 33.3% and negative predictive value was 97.4%. With regards to the secondary endpoint, a cut-off of 9.08%, sensitivity was 71% and specificity 71%. Positive predictive value was 15.8% and negative predictive value was 97.5%. Conclusion: Stagnation or positive increase of C-Reactive Protein level at 48 hours during postoperative care should encourage clinicians to consider further investigations regarding a possible anastomotic leak.