Elevated Serum CRP After Colorectal Surgery Predicts Anastomotic Leakage

A patient undergoes cancer-related surgery.
A patient undergoes cancer-related surgery.
As serum C-reactive protein (CRP) levels tend to rise in infective and inflammatory states, and elevated CRP has been linked to anastomotic leak (AL), these researchers conducted a meta-analysis of current CRP data in AL after colorectal surgery to find out more.

Serum C-reactive protein (CRP) concentrations were found, during a meta-analysis, to predict anastomotic leakage (AL) after colorectal surgery. These findings were published in the International Journal of Colorectal Disease.

Researchers from Sandwell and West Birmingham Hospitals NHS Trust in the United Kingdom searched publication databases through June 2020 for articles about AL and CRP after colorectal resections involving an anastomosis.

The investigators included a total of 23 observational studies of prospective cohort (n=20), retrospective cohort (n=2), and retrospective case-matched cohort (n=1) designs. The studies were rated as having a low (n=12) or moderate (n=11) risk for bias.

The patients (N=6647) underwent laparoscopic, robotic, or open surgeries for diverticular disease, cancer, or inflammatory bowel disease. In total, 482 patients had AL, which was diagnosed at a mean average of 7.7±1.91 days.

Stratified by AL, patients with AL had higher average CRP on postoperative day 1 compared with patients without AL (mean difference [MD] 15.19; 95% CI, 5.88-24.5; P =.001; I2=67%; P =.0002). C-reactive protein continued to increase among the patients with AL to its peak difference on postoperative day 5 (MD 112.1; 95% CI, 89.74-134.45; P <.00001; I2=58%; P <.00001) and remained significantly elevated on postoperative day 7 (MD 106.41; 95% CI, 75.48-137.35; P <.00001; I2=80%; P <.00001).

A receiver operator curve (ROC) analysis identified a CRP cutoff day-by-day that best predicted AL, starting at 110 on day 1 (area under the characteristic curve [AUC] 0.66; 95% CI, 0.47-0.82; P =.111). On day 2, the cutoff was 184 and reached significance (AUC 0.91; 95% CI, 0.74-0.98; P <.0001). The ROC cutoff remained significant but reduced gradually to a value of 96 on postoperative day 7 (AUC 1; 95% CI, 0.77-1; P <.0001).

This analysis was limited by the underlying studies that had significantly high heterogeneity, and nearly half were assessed as having a moderate risk for bias.

These findings suggested that high serum CRP concentrations after colorectal surgery predicted AL, and the presence of such elevations should prompt investigation and treatment for AL.


Yeung D E, Peterknecht E, Hajibandeh S, Hajibandeh S, Torrance AW. C-reactive protein can predict anastomotic leak in colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis. Published online February 8, 2021. doi:10.1007/s00384-021-03854-5