Role of Serum C-Reactive Protein, Interleukin-6, Leukocyte Indices, and Serum Albumin as Predictors of Anastomotic Leak in Colorectal Surgery: A Pilot Study from India

Document Type : Research/Original Article

Authors

1 Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, INDIA

2 Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India

3 Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India

Abstract

Background: Anastomotic leak (AL) following colorectal surgery can lead to significant morbidity and
mortality, with an incidence ranging from 2% to 14%. Early diagnosis and management are crucial for
improving patient outcomes. However, the clinical detection of leaks is often delayed, adversely affecting these
outcomes. Therefore, there is a pressing need for serum markers that can serve as diagnostic tools prior to the
onset of clinical manifestations. The objective of this study is to investigate the changes in serum C-reactive
protein (CRP), albumin, leukocyte indices, and interleukin-6 (IL-6), and to access their association with AL in
colorectal anastomosis.
Methods: This prospective observational pilot study included 30 patients undergoing elective colorectal resection
and anastomosis for both benign and malignant conditions at the Department of Surgical Gastroenterology,
SGPGIMS Lucknow, a tertiary care teaching hospital in northern India, from April 2021 to March 2022.
Serum C-reactive protein (CRP), albumin, total leukocyte count (TLC), complete blood counts, platelet count,
and IL-6 levels were measured preoperatively and postoperatively. Patients were divided into two groups:
Group 1, which experienced anastomotic leaks, and Group 2, which did not. Changes in these markers were
compared preoperatively and on postoperative days (POD) 1, 3, and 7. To compare the changes between groups,
the Mann–Whitney U test was utilized, and multivariate analysis was conducted to identify predictors of
anastomotic leaks using Firth logistic regression. A P value of <0.05 was considered statistically significant.
Results: Group 1 comprised 4 patients (13.3%), while Group 2 included 26 patients (86.7%). A statistically
significant difference was observed in serum CRP levels (P=0.001), neutrophil-to-lymphocyte ratio (NLR)
(P=0.009), and serum IL-6 levels (P=0.03) on POD 3 between group 1 and group 2. In the multivariate analysis
utilizing Firth logistic regression, serum CRP exhibited OR=1.09 and NLR demonstrated OR=1.28.
Conclusion: A significant increase in serum CRP, NLR, and IL6 on POD 3 may serve as valuable markers for
the early detection of AL.

Keywords

References

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Iranian Journal of Colorectal Research
Volume 12, Issue 4
December 2024

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