Importance of C-Reactive Protein As A Clinical Diagnostic Tool For The Recognition of Anastomotic Leakage In Patients Undergoing Large Bowel Anastomosis

Tanweer Ahmed, Zakia Nehal, Imran Khan, Muhammad Mansoor Iqbal, Muhammad Iqbal Khan, Surghra Perveen

Abstract

Objective

To determine the diagnostic importance of C-reactive protein (CRP) in prediction of anastomotic leak in subjects who underwent large bowel anastomosis with CT scan taken as a gold standard.

Study design

Cross sectional study.

Place & Duration of study

Department of Surgery, Unit I, Jinnah Postgraduate Medical Centre Karachi, from February 2017 to August 2017.

Methodology

A total of 115 patients (both male and female) of age group 13-50 years who underwent large bowel anastomosis either electively or in emergency with minimum intra peritoneal contamination, were enrolled. Serum CRP values were acquired on postoperative day (POD) 5 and values >100 mg/L were considered indicative of anastomotic leak out. A CT scan was done for confirmation and occurrence of hyperdense region considered as an anastomotic leak.

Results

Mean age of the subjects was 43.26 ±8.01 year. Males were more commonly underwent surgery (n=73 - 63.5%) as compared to females (n=42 - 36.5%). Anastomotic leakage utilizing CRP was observed in 23 (20%) subjects. On the other hand 18 (15.7%) subjects were observed as an indicator of anastomotic leakage utilizing CT Scan. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall diagnostic accuracy were found as 61.11%, 87.63%, 47.83%, 92.39% and 83.47% respectively.

Conclusion

The diagnostic precision of C-reactive protein was found in recognition of anastomotic leak in patients with large bowel anastomosis considering CT scan as a gold standard.

Key words

C-reactive protein, Anastomotic leak, Bowel anastomosis.