Usefulness of Serum Biomarkers to Predict Anastomotic Leakage After Gastrectomy

Background: /Objectives: Anastomotic leakage (AL) is one of the most feared complications following gastrectomy, with a relatively high incidence rate. The aim of this study was to assess and compare the predictive ability of C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), fibrinogen and mean platelet volume (MPV) in the early diagnosis of post-gastrectomy AL. Methods: A prospective bicentric observational study was conducted including all patients undergoing elective gastrectomy between August 2018 and December 2022, assessing the performance of the noted biomarkers to predict the existence of AL within the first 7 postoperative days (POD). Results: A total of 107 patients were included for analysis. The incidence of AL was 20.56%, and the median day of diagnosis was on POD5 (interquartile range 4-6). CRP, PCT, NLR, PLR and fibrinogen showed significant association with the presence of AL (from POD2 for CRP and fibrinogen and from POD3 for PCT, NLR and PLR). CRP showed the better discrimination on POD4 (cut-off 181.4mg/L; NPV 99%; AUC 0.87, p<0.001); PCT demonstrated the better discrimination on POD7 (cut-off 0.13ng/mL; NPV 98%; AUC 0.84, p<0.001); NLR showed the better discrimination on POD6 (cut-off 6.77; NPV 95%; AUC 0.86, p<0.001); PLR achieved the higher discrimination on POD7 (AUC 0.71; 95%CI 0.58-0.82; cut-off 234; Se 93%; Sp 73%; PPV 47%; NPV 98%; p=0.002); fibrinogen showed the better discrimination on POD5 (AUC 0.74; 95%CI 0.66-0.8; cut-off 734.4; Se 95%; Sp 52%; PPV 35%; NPV 98%; p=0.003). In the comparison of predictive accuracy CPR, PCT and NLR were found superior among all other biomarkers. Conclusions: CRP, PCT and NLR are biomarkers with adequate predictive ability to clinically discard the presence of AL within the first postoperative week.