C-reactive protein (CRP) trajectory as a predictor of anastomotic leakage after rectal cancer resection:  A multicentre cohort study

The APPEAL II Collaborators; V. T. Hoek; C. L. Sparreboom; A. M. Wolthuis; A. G. Menon; G. J. Kleinrensink; A. D'Hoore; N. Komen; J. F. Lange; H. L. van Westreenen; P. G. Doornebosch; J. W. T. Dekker; F. Daams; D. J. Lips; W. M. U. van Grevenstein; T. M. Karsten

doi:10.1111/codi.15963

C-reactive protein (CRP) trajectory as a predictor of anastomotic leakage after rectal cancer resection: A multicentre cohort study

The APPEAL II Collaborators, V. T. Hoek^*, C. L. Sparreboom, A. M. Wolthuis, A. G. Menon, G. J. Kleinrensink, A. D'Hoore, N. Komen, J. F. Lange, H. L. van Westreenen, P. G. Doornebosch, J. W. T. Dekker, F. Daams, D. J. Lips, W. M. U. van Grevenstein, T. M. Karsten

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Aim: This study aimed to identify whether CRP-trajectory measurement, including increase in CRP-level of 50 mg/l per day, is an accurate predictor of anastomotic leakage (AL) in patients undergoing resection for rectal cancer. Methods: A prospective multicentre database was used. CRP was recorded on the first three postoperative days. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operator characteristic (ROC) curve were used to analyse performances of CRP-trajectory measurements between postoperative day (POD) 1–2, 2–3, 1–3 and between any two days. Results: A total of 271 patients were included in the study. AL was observed in 12.5% (34/271). Increase in CRP-level of 50 mg/l between POD 1–2 had a negative predictive value of 0.92, specificity of 0.71 and sensitivity of 0.57. Changes in CRP-levels between POD 2–3 were associated with a negative predictive value, specificity and sensitivity of 0.89, 0.93 and 0.26, respectively. Changes in CRP-levels between POD 1–3 showed a negative predictive value of 0.94, specificity of 0.76 and sensitivity of 0.65. In addition, 50 mg/l changes between any two days showed a negative predictive value of 0.92, specificity of 0.66 and sensitivity of 0.62. The area under the ROC curve for all CRP-trajectory measurements ranged from 0.593–0.700. Conclusion: The present study showed that CRP-trajectory between postoperative days lacks predictive value to singularly rule out AL. Early and safe discharge in patients undergoing rectal surgery for adenocarcinoma cannot be guaranteed based on this parameter. High negative predictive values are mainly caused by the relatively low prevalence of AL.

Original language	English
Pages (from-to)	220-227
Number of pages	8
Journal	Colorectal Disease
Volume	24
Issue number	2
DOIs	https://doi.org/10.1111/codi.15963
Publication status	Published - Feb 2022

Bibliographical note

Funding Information:
No preregistration exists for the reported studies reported in this article. The APPEAL II collaborators: Department of Surgery, Isala Hospital, Zwolle, The Netherlands (H.L. van Westreenen MD PhD); Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands (P.G. Doornebosch MD PhD); Department of Surgery, Reinier de Graaf, Delft, The Netherlands (J.W.T. Dekker MD PhD); Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherland (FDaams MD PhD); Department of Surgery, Medical Spectrum Twente, Twente, The Netherlands (D. J. Lips MD PhD); Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands (W.M.U. van Grevenstein MD PhD); Department of Surgery, OLVG, Amsterdam, The Netherlands (T.M. Karsten MD PhD).

Publisher Copyright:
© 2021 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

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Cite this

The APPEAL II Collaborators, Hoek, V. T., Sparreboom, C. L., Wolthuis, A. M., Menon, A. G., Kleinrensink, G. J., D'Hoore, A., Komen, N., Lange, J. F., van Westreenen, H. L., Doornebosch, P. G., Dekker, J. W. T., Daams, F., Lips, D. J., van Grevenstein, W. M. U., & Karsten, T. M. (2022). C-reactive protein (CRP) trajectory as a predictor of anastomotic leakage after rectal cancer resection: A multicentre cohort study. Colorectal Disease, 24(2), 220-227. https://doi.org/10.1111/codi.15963

@article{343ebfecd6be4c2dbc12eada24123bb6,

title = "C-reactive protein (CRP) trajectory as a predictor of anastomotic leakage after rectal cancer resection: A multicentre cohort study",

abstract = "Aim: This study aimed to identify whether CRP-trajectory measurement, including increase in CRP-level of 50 mg/l per day, is an accurate predictor of anastomotic leakage (AL) in patients undergoing resection for rectal cancer. Methods: A prospective multicentre database was used. CRP was recorded on the first three postoperative days. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operator characteristic (ROC) curve were used to analyse performances of CRP-trajectory measurements between postoperative day (POD) 1–2, 2–3, 1–3 and between any two days. Results: A total of 271 patients were included in the study. AL was observed in 12.5% (34/271). Increase in CRP-level of 50 mg/l between POD 1–2 had a negative predictive value of 0.92, specificity of 0.71 and sensitivity of 0.57. Changes in CRP-levels between POD 2–3 were associated with a negative predictive value, specificity and sensitivity of 0.89, 0.93 and 0.26, respectively. Changes in CRP-levels between POD 1–3 showed a negative predictive value of 0.94, specificity of 0.76 and sensitivity of 0.65. In addition, 50 mg/l changes between any two days showed a negative predictive value of 0.92, specificity of 0.66 and sensitivity of 0.62. The area under the ROC curve for all CRP-trajectory measurements ranged from 0.593–0.700. Conclusion: The present study showed that CRP-trajectory between postoperative days lacks predictive value to singularly rule out AL. Early and safe discharge in patients undergoing rectal surgery for adenocarcinoma cannot be guaranteed based on this parameter. High negative predictive values are mainly caused by the relatively low prevalence of AL.",

author = "{The APPEAL II Collaborators} and Hoek, {V. T.} and Sparreboom, {C. L.} and Wolthuis, {A. M.} and Menon, {A. G.} and Kleinrensink, {G. J.} and A. D'Hoore and N. Komen and Lange, {J. F.} and {van Westreenen}, {H. L.} and Doornebosch, {P. G.} and Dekker, {J. W. T.} and F. Daams and Lips, {D. J.} and {van Grevenstein}, {W. M. U.} and Karsten, {T. M.}",

note = "Funding Information: No preregistration exists for the reported studies reported in this article. The APPEAL II collaborators: Department of Surgery, Isala Hospital, Zwolle, The Netherlands (H.L. van Westreenen MD PhD); Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands (P.G. Doornebosch MD PhD); Department of Surgery, Reinier de Graaf, Delft, The Netherlands (J.W.T. Dekker MD PhD); Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherland (FDaams MD PhD); Department of Surgery, Medical Spectrum Twente, Twente, The Netherlands (D. J. Lips MD PhD); Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands (W.M.U. van Grevenstein MD PhD); Department of Surgery, OLVG, Amsterdam, The Netherlands (T.M. Karsten MD PhD). Publisher Copyright: {\textcopyright} 2021 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.",

year = "2022",

month = feb,

doi = "10.1111/codi.15963",

language = "English",

volume = "24",

pages = "220--227",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "2",

}

The APPEAL II Collaborators, Hoek, VT , Sparreboom, CL, Wolthuis, AM, Menon, AG, Kleinrensink, GJ, D'Hoore, A, Komen, N, Lange, JF, van Westreenen, HL, Doornebosch, PG, Dekker, JWT, Daams, F, Lips, DJ, van Grevenstein, WMU & Karsten, TM 2022, 'C-reactive protein (CRP) trajectory as a predictor of anastomotic leakage after rectal cancer resection: A multicentre cohort study', Colorectal Disease, vol. 24, no. 2, pp. 220-227. https://doi.org/10.1111/codi.15963

TY - JOUR

T1 - C-reactive protein (CRP) trajectory as a predictor of anastomotic leakage after rectal cancer resection

T2 - A multicentre cohort study

AU - The APPEAL II Collaborators

AU - Hoek, V. T.

AU - Sparreboom, C. L.

AU - Wolthuis, A. M.

AU - Menon, A. G.

AU - Kleinrensink, G. J.

AU - D'Hoore, A.

AU - Komen, N.

AU - Lange, J. F.

AU - van Westreenen, H. L.

AU - Doornebosch, P. G.

AU - Dekker, J. W. T.

AU - Daams, F.

AU - Lips, D. J.

AU - van Grevenstein, W. M. U.

AU - Karsten, T. M.

N1 - Funding Information: No preregistration exists for the reported studies reported in this article. The APPEAL II collaborators: Department of Surgery, Isala Hospital, Zwolle, The Netherlands (H.L. van Westreenen MD PhD); Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands (P.G. Doornebosch MD PhD); Department of Surgery, Reinier de Graaf, Delft, The Netherlands (J.W.T. Dekker MD PhD); Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherland (FDaams MD PhD); Department of Surgery, Medical Spectrum Twente, Twente, The Netherlands (D. J. Lips MD PhD); Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands (W.M.U. van Grevenstein MD PhD); Department of Surgery, OLVG, Amsterdam, The Netherlands (T.M. Karsten MD PhD). Publisher Copyright: © 2021 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

PY - 2022/2

Y1 - 2022/2

N2 - Aim: This study aimed to identify whether CRP-trajectory measurement, including increase in CRP-level of 50 mg/l per day, is an accurate predictor of anastomotic leakage (AL) in patients undergoing resection for rectal cancer. Methods: A prospective multicentre database was used. CRP was recorded on the first three postoperative days. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operator characteristic (ROC) curve were used to analyse performances of CRP-trajectory measurements between postoperative day (POD) 1–2, 2–3, 1–3 and between any two days. Results: A total of 271 patients were included in the study. AL was observed in 12.5% (34/271). Increase in CRP-level of 50 mg/l between POD 1–2 had a negative predictive value of 0.92, specificity of 0.71 and sensitivity of 0.57. Changes in CRP-levels between POD 2–3 were associated with a negative predictive value, specificity and sensitivity of 0.89, 0.93 and 0.26, respectively. Changes in CRP-levels between POD 1–3 showed a negative predictive value of 0.94, specificity of 0.76 and sensitivity of 0.65. In addition, 50 mg/l changes between any two days showed a negative predictive value of 0.92, specificity of 0.66 and sensitivity of 0.62. The area under the ROC curve for all CRP-trajectory measurements ranged from 0.593–0.700. Conclusion: The present study showed that CRP-trajectory between postoperative days lacks predictive value to singularly rule out AL. Early and safe discharge in patients undergoing rectal surgery for adenocarcinoma cannot be guaranteed based on this parameter. High negative predictive values are mainly caused by the relatively low prevalence of AL.

AB - Aim: This study aimed to identify whether CRP-trajectory measurement, including increase in CRP-level of 50 mg/l per day, is an accurate predictor of anastomotic leakage (AL) in patients undergoing resection for rectal cancer. Methods: A prospective multicentre database was used. CRP was recorded on the first three postoperative days. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operator characteristic (ROC) curve were used to analyse performances of CRP-trajectory measurements between postoperative day (POD) 1–2, 2–3, 1–3 and between any two days. Results: A total of 271 patients were included in the study. AL was observed in 12.5% (34/271). Increase in CRP-level of 50 mg/l between POD 1–2 had a negative predictive value of 0.92, specificity of 0.71 and sensitivity of 0.57. Changes in CRP-levels between POD 2–3 were associated with a negative predictive value, specificity and sensitivity of 0.89, 0.93 and 0.26, respectively. Changes in CRP-levels between POD 1–3 showed a negative predictive value of 0.94, specificity of 0.76 and sensitivity of 0.65. In addition, 50 mg/l changes between any two days showed a negative predictive value of 0.92, specificity of 0.66 and sensitivity of 0.62. The area under the ROC curve for all CRP-trajectory measurements ranged from 0.593–0.700. Conclusion: The present study showed that CRP-trajectory between postoperative days lacks predictive value to singularly rule out AL. Early and safe discharge in patients undergoing rectal surgery for adenocarcinoma cannot be guaranteed based on this parameter. High negative predictive values are mainly caused by the relatively low prevalence of AL.

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U2 - 10.1111/codi.15963

DO - 10.1111/codi.15963

M3 - Article

C2 - 34706131

SN - 1462-8910

VL - 24

SP - 220

EP - 227

JO - Colorectal Disease

JF - Colorectal Disease

IS - 2

ER -