Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature

Table 2 Laboratory tests

Author	Type of study	Loe	n (CAL/non-CAL)	Colorectal/rectum	Stapled/handsewn anastomosis	Study subject/tool	Cut-off value	Se	Sp	PPV	NPV	ROC	Main outcome	OnsetCAL(POD)
Slotwinksi et al[29]	Pro	3b	2/16	Colorectal	?	sTNF-R1, IL-1RA/-6/-8/-10, CRP	-	-	-	-	-	-	TNF higher at POD 1 in CAL	?
Iversen et al[30]	Pro	3b	17/341	Colorectal	Both	s-Fibrin, TAT-complex, PT-f1/-2	-	-	-	-	-	-	PT-f1/-2, TAT-complex, s-Fibrin higher at POD 1/2 in CAL	7
Woeste et al[25]	Retro	3b	26/342	Colorectal	Both	CRP	-	-	-	-	-	-	CRP higher from POD 3 to POD 7 in CAL	8,7
Warschkow et al[24]	Meta	3a	?/1832	Colorectal	Both	CRP	135 mg/L at POD 4	0.680	0.830	0.560	0.89	-	CRP < 135 mg/L at POD 4 discharge is safe	?
Kornerin et al[24]	Retro	3b3	18/231	Colorectal	Both	CRP	190 mg/L at POD 3	0.820	0.730	-	-	0.820	Persisting elevation of CRP is indicative for CAL	8
Mackayin et al[24]	Pro	3b3	5/160	Colorectal	?	CRP	145 mg/L at POD 4	0.850	0.860	0.610	0.96	-	CRP > 145 mg/L at POD 4 is highly predictive for CAL	?
Ortegain et al[24]	Pro	3b3	21/133	Colorectal	Both	CRP	125 mg/L at POD 4	0.820	0.960	-	-	-	CRP > 125 mg/L at POD 4 discharge is not safe	6
Welschin et al[24]	Pro	3b3	22/961	Rectum	Staples	CRP	140 mg/L at POD 3	0.802	0.812	0.862	-	-	Persisting elevation of CRP is indicative for CAL	8
Warschkowin et al[24]	Retro	3b3	89/1115	Colorectal	?	CRP	143 mg/L at POD 4	0.750	0.710	0.190	0.97	-	Use CRP as screening at POD 4	9
Platt et al[26]	Pro	3b	26/454	Colorectal	Both	CRP	190 mg/L at POD 3	0.772	0.802	-	-	0.892	CRP at POD 3 is useful for predicting CAL	6-8
Matthiessen et al[27]	Pro	3b	9/33	Rectum	?	CRP	-	-	-	-	-	-	CRP higher from POD 2 in CAL	8
Almeida et al[28]	Retro	3b	24/149	Colorectal	?	CRP	140 mg/L at POD 3	0.780	0.860	-	-	-	CRP sign higher from POD 2 in CAL	7

¹Selected groups;

²All complications;

³Included in meta-analysis. Pro: Prospective; Retro: Retrospective; Meta: Meta-analysis; Loe: Level of evidence; CAL: Colorectal anastomotic leakage; TNF: Tumour necrosis factor; IL: Interleukin; CRP: C-reactive protein; TAT: Thrombin-antithrombin complexes; PT: Prothrombin; POD: Postoperative day; Se: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; ROC: Receiver-operating characteristic curve.