The Role of C-Reactive Protein in Diagnosing Anastomosis Leakage in Patients with a Large Bowel Anastomosis

Abstract

Objective: In this study, our objective was to assess the diagnostic significance of C-reactive protein (CRP) as a predictive indicator for detecting anastomotic leakage in individuals who have undergone anastomosis of the large bowel. We employed computed tomography (CT) scans as the reference standard against which CRP's diagnostic utility was evaluated. Study design: A cross-sectional study Place and Duration: This study was conducted in Peoples University of medical and Health sciences for women Nawabshah, Pakistan from March 2022 to March 2023. Methodology: We enrolled 110 patients (ages 12-50 years, both genders) who underwent large bowel anastomosis, elective or emergency, achieving minimal cross-contamination. A concise medical history capturing symptoms and demographic details was collected. Bowel anastomoses were executed using the hand-sewn technique. Postoperative day 5 CRP levels >100 mg/L indicated an anastomotic leak. CT scans confirmed leaks through hyper density. Results: The subjects had a mean age of 42.89 ± 7.89 years. Surgery was more common in males (n=69, 62.72%) compared to females (n=41, 37.27%). CRP-based detection identified anastomotic leakage in 22 subjects (20%), while CT scans indicated leakage in 17 subjects (15.45%). Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, and overall diagnostic accuracy were 47.75%, 92.41%, 61.09%, 87.63%, and 83.52%, respectively. Conclusion: Considering CT scan as the gold standard, the diagnostic precision of CRP was noted in identifying leakage of anastomosis in patients undergoing large bowel anastomosis.