C.E. Paterson1, N. Shah1, A.G. Hill1 1South Auckland Clinical School, Auckland, New Zealand
Introduction: Early diagnosis of anastomotic leak following elective colonic surgery remains challenging. Procalcitonin is a potential biomarker for anastomotic leak. The aim of this study was to investigate the use of procalcitonin as a biomarker for the detection of anastomotic leak following elective colonic surgery.
Methods: A prospective observational study was conducted across four hospitals in Aotearoa, New Zealand over a three-year period. Perioperative blood samples were collected from consenting adults undergoing elective colonic surgery. Preoperative and postoperative days 1 to 5 serum procalcitonin levels were analysed. Statistical analysis was performed to compare participants who developed an anastomotic leak to participants who did not.
Results: A total of 191 participants had sufficient data for analysis. Thirteen (6.8%) developed an anastomotic leak. There were no statistically significant differences in median serum procalcitonin levels between the anastomotic leak group and no leak group across the preoperative and postoperative days 1 to 5 (Mann-Whitney U, all p-values > 0.05). A repeated measures ANOVA showed a statistically significant effect of anastomotic leak on serum procalcitonin levels (p = 0.032), and a statistically significant effect of timepoint on procalcitonin levels (p < 0.0001). However, the interaction effect between anastomotic leak and timepoint was not statistically significant (p = 0.068). Multivariate logistic regression modelling found that none of the preoperative or postoperative days 1 to 5 serum procalcitonin levels were statistically significant in predicting anastomotic leak (all p-values > 0.05). The highest AUC ROC was 0.659 on postoperative day 4.
Conclusion: Procalcitonin is not independently useful as a biomarker for the detection of anastomotic leak. It is likely that a combination of biomarkers will be useful in the early detection of anastomotic leak, and this should be the focus of future studies.