Clinical Value Of The White Cell Count,c-reactive Protein And Procalcitonin In Prediction Of Anastomotic Leakage After Colorectal Cancer Surgery

Objective:To explore the clinical value of the white cell count (WBC),C-reactive protein (CRP) and procalcitonin (PCT) in early identification of anastomotic leakage (AL)after colorectal resection,and to construct a Nomogram to predict the individual risk of AL.Methods:We conducted a retrospective case-control study including 173 patients with colorectal cancer who underwent laparoscopic radical colorectal resection from January 2017 to June 2019 in the General Surgery Center of the Affiliated Hospital of Qingdao University.The main observation indicators are PCT,CRP and WBC on the postoperative day 1 (POD1),POD3 and POD5,and the primary endpoint investigated was AL.SPSS 22.0 software was used to analyze the data,Kruskall-Wallis test was used to compare the measurement data,χ2 test was used to compare the counting data.ROC curve was drawn to compare the prediction accuracy of PCT,CRP,WBC to AL.R software was used to construct the nomogram based on multivariate Logistic regression analysis of AL.Calibration curve was drawn to analysis the calibration degree of the model.Stata software was used to draw the ROC curve to analyze the discrimination degree of the model.Results:A total of 173 patients were included.AL was detected in 13 patients (7.5%).The predictive performance of PCT,CRP,and WBC for AL were the best on the third day after surgery,with AUC of 0.937(95%CI 0.900-0.985) and 0.909(95%CI 0.874-0.968) and 0.825(95%CI 0.758-0.884),respectively,and the negative predictive values obtained with the best cut-off values of 0.75ng/mL,84.05mg/L and 11.93*109/L were 97.6%,96.6% and 87.1%,respectively.The predictive accuracy of the combined detection of PCT and CRP for AL on POD3 and POD5 were better than the single index test (AUC 0.964 vs 0.956).A nomogram for predicting AL by PCT,CRP and WBC on POD3 was constructed.The calibration curve showed that the model had a good calibration,and the average absolute error between the actual risk and the predicted risk was 0.042.ROC curve showed that the model had a good degree of differentiation,AUC was 0.9752(95%CI0.947-1),the specificity and sensitivity of the model are 100.0% and 87.36%,respectively.Conclusions:PCT and CRP are reliable indicators for early identification of AL and safe discharge after colorectal resection.The nomogram constructed by PCT,CRP and WBC on POD3 may effectively guide the individual prediction of AL.