New approaches to prediction of colonic anastomotic leakage

АIM: to assess the prognostic significance of markers of oxidative stress, collagen degradation and intra-abdominal hypertension in the development of colorectal anastomotic leakage.

PATIENTS AND METHODS: retrospective case-control study was conducted including 65 patients after colorectal resection: the study group (n = 43) comprised patients who developed anastomotic leakage, and the comparison group (n = 22) included patients with an uneventful postoperative course. The groups were comparable in terms of age, sex, operative time and intraoperative blood loss (p > 0.05). On postoperative days 2–3, serum levels of malondialdehyde (MDA), free hydroxyproline, conjugated dienes, ascorbic acid, lactate and serotonin, as well as intra-abdominal pressure (IAP), were measured.

RESULTS: Patients with CAL had significantly higher median levels of MDA (4,4 [3,9–4,7] vs 3,1 [2,4–3,6] nmol/ mL; p < 0.001), free hydroxyproline (18,0 [15,7–19,6] vs 12,7 [11,1–14,8] μmol/L; p < 0.001) and IAP (16,1 [14,2–17,9] vs 10.5 [8,8–15,1] mmHg; p < 0.001) on postoperative days 2–3 as compared with controls. ROC analysis showed good discriminative ability of free hydroxyproline for CAL: AUC 0.83 (95% confidence interval (CI) 0.72– 0.93; p < 0.001); at a cut-off ≥ 15 μmol/L, sensitivity was 79.1% (95% CI 63.9–89.9), specificity 77.3% (95% CI 54.6–92.2), positive predictive value (PPV) 87.2% (95% CI 72.6–95.7) and negative predictive value (NPV) 65.4% (95% CI 44.3–82.8). IAP ≥ 15 mmHg yielded an AUC of 0.78 (95% CI 0.65–0.90; p < 0.001), sensitivity 69.8% and specificity 72.7%; MDA ≥ 4.0 nmol/mL — AUC 0.80 (95% CI 0.68–0.91; p < 0.001), sensitivity 74.4% and specificity 77.3%. In multivariable logistic regression, free hydroxyproline (odds ratio (OR) 1.35; 95% CI 1.08–1.69; p = 0.009), IAP (OR 1.35; 95% CI 1.10–1.65; p = 0.004) and MDA (OR 2.86; 95% CI 1.25–6.56; p = 0.013) were identified as independent predictors of CAL. The combined three-marker model showed high prognostic accuracy: AUC 0.93 (95% CI 0.84–0.98; p < 0.001); p (Hosmer-Lemeshow test) = 0.34; Nagelkerke R² = 0.65.

CONCLUSION: comprehensive assessment of collagenolysis markers and intra-abdominal hypertension in the early postoperative period allows highly accurate prediction of the risk of anastomotic leakage

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