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Systematic review and meta-analysis of the use of serum procalcitonin levels to predict intra-abdominal infections after colorectal surgery

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Abstract

Purpose

There has been much recent interest in the use of procalcitonin (PCT) as a marker of intra-abdominal infection (IAI) following colorectal surgery. However, the literature remains divided on the value of PCT in this setting. This meta-analysis aims to evaluate the value of PCT in predicting IAI after colorectal surgery.

Methods

Systemic literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews to identify studies evaluating the diagnostic accuracy of PCT as a predictor for detecting IAI on postoperative days (POD) 3 to 5 following colorectal surgery. A meta-analysis was performed using random effect model and pooled predictive parameters as well as cut-off values for POD 3 to 5 were derived.

Results

Eight studies consisting 1629 patients were included. The pooled prevalence of IAI was 5.7% on POD 3, 9.7% on POD 4, and 6.3% on POD 5. The pooled AUC for POD 3 to 5 were 0.83 (95% CI 0.78–0.88), 0.79 (95% CI 0.64–0.93), and 0.94 (95% CI 0.91–0.97), respectively. The derived PCT cut-off values were 1.45 ng/ml on POD 3, 1.28 ng/ml on POD 4, and 1.26 ng/ml on POD 5. PCT had the highest diagnostic capability on POD 5 with diagnostic odds ratio of 32.9 (95% CI 15.01–69.88), sensitivity of 0.78 (95% CI 0.65–0.89), and specificity of 0.88 (95% CI 0.85–0.90).

Conclusions

PCT is a useful diagnostic predictor of IAI after colorectal surgery. It has the greatest diagnostic accuracy on POD 5 and can help guide safe discharge of patients after colorectal surgery.

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References

  1. Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H (2014) Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg 259(5):930–938. https://doi.org/10.1097/SLA.0b013e3182a6f2fc

    Article  PubMed  Google Scholar 

  2. McArdle CS, McMillan DC, Hole DJ (2005) Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg 92(9):1150–1154. https://doi.org/10.1002/bjs.5054

    Article  CAS  PubMed  Google Scholar 

  3. Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T (2014) Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 101(4):424–432; discussion 432. https://doi.org/10.1002/bjs.9395

    Article  CAS  PubMed  Google Scholar 

  4. Krarup PM, Jorgensen LN, Harling H, Danish Colorectal Cancer G (2014) Management of anastomotic leakage in a nationwide cohort of colonic cancer patients. J Am Coll Surg 218(5):940–949. https://doi.org/10.1016/j.jamcollsurg.2014.01.051

    Article  PubMed  Google Scholar 

  5. Macarthur DC, Nixon SJ, Aitken RJ (1998) Avoidable deaths still occur after large bowel surgery. Scottish audit of surgical mortality, Royal College of Surgeons of Edinburgh. Br J Surg 85(1):80–83. https://doi.org/10.1046/j.1365-2168.1998.00554.x

    Article  CAS  PubMed  Google Scholar 

  6. Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P (1999) Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 189(6):554–559. https://doi.org/10.1016/S1072-7515(99)00207-0

    Article  CAS  PubMed  Google Scholar 

  7. Bellows CF, Webber LS, Albo D, Awad S, Berger DH (2009) Early predictors of anastomotic leaks after colectomy. Tech Coloproctol 13(1):41–47. https://doi.org/10.1007/s10151-009-0457-7

    Article  CAS  PubMed  Google Scholar 

  8. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA (2007) Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg 245(2):254–258. https://doi.org/10.1097/01.sla.0000225083.27182.85

    Article  PubMed  PubMed Central  Google Scholar 

  9. Basse L, Hjort Jakobsen D, Billesbolle P, Werner M, Kehlet H (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232(1):51–57. https://doi.org/10.1097/00000658-200007000-00008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Pritts TA, Nussbaum MS, Flesch LV, Fegelman EJ, Parikh AA, Fischer JE (1999) Implementation of a clinical pathway decreases length of stay and cost for bowel resection. Ann Surg 230(5):728–733. https://doi.org/10.1097/00000658-199911000-00017

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG (2014) Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg 101(4):339–346. https://doi.org/10.1002/bjs.9354

    Article  CAS  PubMed  Google Scholar 

  12. Warschkow R, Beutner U, Steffen T, Muller SA, Schmied BM, Guller U, Tarantino I (2012) Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1832 patients. Ann Surg 256(2):245–250. https://doi.org/10.1097/SLA.0b013e31825b60f0

    Article  PubMed  Google Scholar 

  13. Wacker C, Prkno A, Brunkhorst FM, Schlattmann P (2013) Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 13(5):426–435. https://doi.org/10.1016/S1473-3099(12)70323-7

    Article  CAS  PubMed  Google Scholar 

  14. Dominguez-Comesana E, Lopez-Gomez V, Estevez-Fernandez SM, Marino Padin E, Ballinas-Miranda J, Carrera-Dacosta E, Pinon-Cimadevila MA, Barreiro-Morandeira F (2014) Procalcitonin and C-reactive protein as early indicators of postoperative intra-abdominal infection after surgery for gastrointestinal cancer. Cir Esp 92(4):240–246. https://doi.org/10.1016/j.ciresp.2013.09.015

    Article  PubMed  Google Scholar 

  15. Facy O, Paquette B, Orry D, Binquet C, Masson D, Bouvier A, Fournel I, Charles PE, Rat P, Ortega-Deballon P, Study I (2016) Diagnostic accuracy of inflammatory markers as early predictors of infection after elective colorectal surgery: results from the IMACORS study. Ann Surg 263(5):961–966. https://doi.org/10.1097/SLA.0000000000001303

    Article  PubMed  Google Scholar 

  16. Giaccaglia V, Salvi PF, Antonelli MS, Nigri G, Pirozzi F, Casagranda B, Giacca M, Corcione F, de Manzini N, Balducci G, Ramacciato G (2016) Procalcitonin reveals early dehiscence in colorectal surgery: the PREDICS study. Ann Surg 263(5):967–972. https://doi.org/10.1097/SLA.0000000000001365

    Article  PubMed  Google Scholar 

  17. Lagoutte N, Facy O, Ravoire A, Chalumeau C, Jonval L, Rat P, Ortega-Deballon P (2012) C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery: pilot study in 100 patients. J Visc Surg 149(5):e345–e349. https://doi.org/10.1016/j.jviscsurg.2012.09.003

    Article  CAS  PubMed  Google Scholar 

  18. Silvestre J, Rebanda J, Lourenco C, Povoa P (2014) Diagnostic accuracy of C-reactive protein and procalcitonin in the early detection of infection after elective colorectal surgery - a pilot study. BMC Infect Dis 14(1):444. https://doi.org/10.1186/1471-2334-14-444

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cousin F, Ortega-Deballon P, Bourredjem A, Doussot A, Giaccaglia V, Fournel I (2016) Diagnostic accuracy of Procalcitonin and C-reactive protein for the early diagnosis of intra-abdominal infection after elective colorectal surgery: a meta-analysis. Ann Surg 264(2):252–256. https://doi.org/10.1097/SLA.0000000000001545

    Article  PubMed  Google Scholar 

  20. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM, Group Q (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536. https://doi.org/10.7326/0003-4819-155-8-201110180-00009

    Article  PubMed  Google Scholar 

  21. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1–34. https://doi.org/10.1016/j.jclinepi.2009.06.006

    Article  PubMed  Google Scholar 

  22. Freeman MF, John W (1950) Tukey. “Transformations related to the angular and the square root.” the. Ann Math Stat 21(4):607–611. http://www.jstor.org/stable/2236611. https://doi.org/10.1214/aoms/1177729756

    Article  Google Scholar 

  23. Macaskill P GC, Deeks JJ, Harbord RM, Takwoingi Y. Chapter, 10: Analysing and presenting results. In: Deeks JJ BP, Gatsonis C (editors), Cochrane, Cochrane HfSRoDTAVT, Collaboration Afhscohsco

  24. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  25. Zawadzki M, Czarnecki R, Rzaca M, Obuszko Z, Velchuru VR, Witkiewicz W (2016) C-reactive protein and procalcitonin predict anastomotic leaks following colorectal cancer resections - a prospective study. Wideochir Inne Tech Maloinwazyjne 10(4):567–573. https://doi.org/10.5114/wiitm.2015.56999

    PubMed  Google Scholar 

  26. Garcia-Granero A, Frasson M, Flor-Lorente B, Blanco F, Puga R, Carratala A, Garcia-Granero E (2013) Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum 56(4):475–483. https://doi.org/10.1097/DCR.0b013e31826ce825

    Article  PubMed  Google Scholar 

  27. Takakura Y, Hinoi T, Egi H, Shimomura M, Adachi T, Saito Y, Tanimine N, Miguchi M, Ohdan H (2013) Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery. Langenbeck's Arch Surg 398(6):833–839. https://doi.org/10.1007/s00423-013-1095-0

    Article  Google Scholar 

  28. Giaccaglia V, Salvi PF, Cunsolo GV, Sparagna A, Antonelli MS, Nigri G, Balducci G, Ziparo V (2014) Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery. J Crit Care 29(4):528–532. https://doi.org/10.1016/j.jcrc.2014.03.036

    Article  CAS  PubMed  Google Scholar 

  29. Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56(11):1129–1135. https://doi.org/10.1016/S0895-4356(03)00177-X

    Article  PubMed  Google Scholar 

  30. Adamina M, Warschkow R, Naf F, Hummel B, Rduch T, Lange J, Steffen T (2014) Monitoring c-reactive protein after laparoscopic colorectal surgery excludes infectious complications and allows for safe and early discharge. Surg Endosc 28(10):2939–2948. https://doi.org/10.1007/s00464-014-3556-0

    Article  PubMed  Google Scholar 

  31. Korner H, Nielsen HJ, Soreide JA, Nedrebo BS, Soreide K, Knapp JC (2009) Diagnostic accuracy of C-reactive protein for intraabdominal infections after colorectal resections. J Gastrointest Surg 13(9):1599–1606. https://doi.org/10.1007/s11605-009-0928-1

    Article  PubMed  Google Scholar 

  32. MacKay GJ, Molloy RG, O'Dwyer PJ (2011) C-reactive protein as a predictor of postoperative infective complications following elective colorectal resection. Color Dis 13(5):583–587. https://doi.org/10.1111/j.1463-1318.2010.02236.x

    Article  CAS  Google Scholar 

  33. Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, McMillan DC (2012) C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol 19(13):4168–4177. https://doi.org/10.1245/s10434-012-2498-9

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore

    Winson Jianhong Tan, Min Hoe Chew, Fung Joon Foo, Choong Leong Tang & Wah Siew Tan

  2. Department of General Surgery, Sengkang Health, Singapore, Singapore

    Winson Jianhong Tan, Min Hoe Chew & Fung Joon Foo

  3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Wan Qi Ng

  4. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore

    Rehena Sultana & Nurun Nisa de Souza

  5. Epidemiology Department, Singapore Clinical Research Institute Pte Ltd, Singapore, Singapore

    Nurun Nisa de Souza

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This paper was presented as an oral presentation in the Association of Surgeons of Great Britain and Ireland 2017 Surgical Congress.

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Tan, W.J., Ng, W.Q., Sultana, R. et al. Systematic review and meta-analysis of the use of serum procalcitonin levels to predict intra-abdominal infections after colorectal surgery. Int J Colorectal Dis 33, 171–180 (2018). https://doi.org/10.1007/s00384-017-2956-8

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