Is serum presepsin levels had accurate discriminative ability for patients vulnerable to develop anastomotic leakage after colorectal anastomosis? A cohort study

Objectives
Evaluation of the predictive value of serial estimations of serum presepsin (PSP), C-reactive protein (CRP), and procalcitonin (PCT) for the development of infective complications and/or anastomotic leakage (AL) after elective colorectal resection with anastomosis for N0M0 colorectal cancers.
Patients and methods
During 7-year study period, 113 patients underwent colorectal resection; postoperative (PO) morbidities were graded according to the comprehensive complication index (CCI). Five venous blood samples (T1–5) were collected at the time of induction of anesthesia, immediate, 1 day, 3 days, and 5 days after surgery for blood leukocytic count, and calculation of neutrophil-to-lymphocyte ratio and estimation of serum levels of the studied cytokines. Study outcome is the ability of serum cytokines’ levels estimated in T2 sample to predict the possibility for the development of AL.
Results
Incidence of PO infective morbidities was 31%, incidence of AL was 8.85%, and PO mortality rate was 2.65%. Operative time was significantly longer; the total score of the CCI was significantly higher and PO hospital stay was significantly longer for patients who had AL. Patients who developed AL had significantly higher neutrophil-to-lymphocyte ratio in T3–5 samples than in the T1 sample. Mean serum levels of the studied cytokines were significantly higher in T2–5 samples than in T1 sample with significantly higher levels in patients who developed AL. Regression analysis defined high serum levels of PSP and PCT in the T3 sample and CRP levels in T5 sample as predictors of AL and high levels of the three biomarkers in the T3 sample could predict mortality. Automatic linear regression defined high serum PSP levels in the T3 sample and long operative time as significant predictors for high CCI and bad outcome with accuracy rates of 61 and 39%, respectively.
Conclusion
The level of serum biomarkers could predict AL, but PSP was superior to CRP and PCT. High serum PSP levels in T2 sample can accurately predict high CCI for PO complications.