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Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients

Background: In colorectal cancer, C-reactive protein (CRP) levels on postoperative days 3–4 have a strong negative predictive value for an anastomotic leak, with threshold values of ~15 on post-operative day (POD) 3 and ~13 on POD 4. In Crohn’s disease, CRP levels are perceived as unreliable in the...

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Autores principales: Slavin, Moran, Goldstein, Avigayil, Raguan, Barak, Rudnicki, Yaron, Avital, Shmuel, White, Ian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780083/
https://www.ncbi.nlm.nih.gov/pubmed/35055369
http://dx.doi.org/10.3390/jpm12010054
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author Slavin, Moran
Goldstein, Avigayil
Raguan, Barak
Rudnicki, Yaron
Avital, Shmuel
White, Ian
author_facet Slavin, Moran
Goldstein, Avigayil
Raguan, Barak
Rudnicki, Yaron
Avital, Shmuel
White, Ian
author_sort Slavin, Moran
collection PubMed
description Background: In colorectal cancer, C-reactive protein (CRP) levels on postoperative days 3–4 have a strong negative predictive value for an anastomotic leak, with threshold values of ~15 on post-operative day (POD) 3 and ~13 on POD 4. In Crohn’s disease, CRP levels are perceived as unreliable in the postoperative period because of the underlying inflammatory process. The aim of this study was to determine whether postoperative CRP levels can be used to rule out anastomotic leaks in patients with Crohn’s disease and to set CRP threshold values for this population. Methods: This was a retrospective study of a population of Crohn’s disease patients who underwent surgery with bowel anastomoses at a single high-volume center between 1/2012 and 12/2017. The operations were performed by a single colorectal consultant who is an inflammatory bowel disease specialist. Results: Ninety-two operations were performed. A CRP level of 19.56 mg/dL on postoperative day 3 had an area under the curve of 0.865 (sensitivity 88%, specificity 73%) and a negative predictive value (NPV) of 98% for an anastomotic leak. Patients with an anastomotic leak showed a trend towards decreased postoperative albumin levels (p = 0.06). Conclusions: Mean CRP levels and CRP threshold values were indeed higher in the study population compared with those in colorectal cancer patients. Threshold values were set at 20.3 mg/dL on POD 3, 19.5 mg/dL on POD 4 and 16.7 mg/dL on POD 5. These values had high NPVs and can be used to rule out anastomotic leaks in patients with Crohn’s disease after surgery with bowel anastomosis.
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spelling pubmed-87800832022-01-22 Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients Slavin, Moran Goldstein, Avigayil Raguan, Barak Rudnicki, Yaron Avital, Shmuel White, Ian J Pers Med Article Background: In colorectal cancer, C-reactive protein (CRP) levels on postoperative days 3–4 have a strong negative predictive value for an anastomotic leak, with threshold values of ~15 on post-operative day (POD) 3 and ~13 on POD 4. In Crohn’s disease, CRP levels are perceived as unreliable in the postoperative period because of the underlying inflammatory process. The aim of this study was to determine whether postoperative CRP levels can be used to rule out anastomotic leaks in patients with Crohn’s disease and to set CRP threshold values for this population. Methods: This was a retrospective study of a population of Crohn’s disease patients who underwent surgery with bowel anastomoses at a single high-volume center between 1/2012 and 12/2017. The operations were performed by a single colorectal consultant who is an inflammatory bowel disease specialist. Results: Ninety-two operations were performed. A CRP level of 19.56 mg/dL on postoperative day 3 had an area under the curve of 0.865 (sensitivity 88%, specificity 73%) and a negative predictive value (NPV) of 98% for an anastomotic leak. Patients with an anastomotic leak showed a trend towards decreased postoperative albumin levels (p = 0.06). Conclusions: Mean CRP levels and CRP threshold values were indeed higher in the study population compared with those in colorectal cancer patients. Threshold values were set at 20.3 mg/dL on POD 3, 19.5 mg/dL on POD 4 and 16.7 mg/dL on POD 5. These values had high NPVs and can be used to rule out anastomotic leaks in patients with Crohn’s disease after surgery with bowel anastomosis. MDPI 2022-01-05 /pmc/articles/PMC8780083/ /pubmed/35055369 http://dx.doi.org/10.3390/jpm12010054 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Slavin, Moran
Goldstein, Avigayil
Raguan, Barak
Rudnicki, Yaron
Avital, Shmuel
White, Ian
Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients
title Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients
title_full Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients
title_fullStr Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients
title_full_unstemmed Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients
title_short Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients
title_sort postoperative crp levels can rule out anastomotic leaks in crohn’s disease patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780083/
https://www.ncbi.nlm.nih.gov/pubmed/35055369
http://dx.doi.org/10.3390/jpm12010054
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