CARPAL: CRP to Albumin Ratio as Predictor of Anastomotic Leak

Kamyar Kahnamoui, Dharini Ilangomaran, Savannah Silva, Travis Schroeder, Forough Farrokhyar, Amin Nalin, Niv Sne and Ilun Yang

Department of Surgery, McMaster University, Canada Department of Surgery, St. Joseph's Healthcare Hamilton, Canada

^*Correspondance to: Dharini Ilangomaran 

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Abstract:

Background: Anastomotic leak results in morbidity, mortality, and financial burden on the healthcare system. Objective: To explore whether CRP to albumin ratio is a predictor of anastomotic leak in patients undergoing elective colorectal cancer surgery. Methods: Prospective chart review of adult patients undergoing elective colorectal surgery at 3 academic hospitals. Inclusion criteria: elective operation, colorectal anastomosis, aged 18 or older. Exclusion criteria: non-malignant cases (inflammatory bowel disease, fistulas, etc.), patients under 18, emergency operations. CRP and albumin levels were collected pre-operatively and POD 3. Data collected included: surgeon, age, sex, length of stay, laparoscopic/open, colonic/rectal anastomosis, leak within 30 days, CRP and albumin levels. Results: 339 cases were included, with a mean age of 68.7; 47.2% female and 52.8% male; the majority laparoscopic (91.7%) rather than open (6.2%). There were both colonic (60.5%) and rectal (39.5%) anastomoses. Of 339 cases, 17 leaks were identified (5.01% leak rate). Mean POD 3 CRP for leak was 221.28 (SD 82.22), whereas no leak was 96.76 (SD 70.21), p<0.001. Mean POD 3 CRP/Albumin Ratio in leak was 7.98 (SD 2.74), and no leak 3.86 (3.06), p<0.001. POD 3 Albumin values were not significantly different between leak and no leak. There was no significant difference between the CRP values of patients who underwent open and laparoscopic procedures. The POD3 CRP of 155.0 mg/L presented the highest Youden’s J index (0.678) with 83.5% sensitivity and 84.5% specificity. Conclusion(s): Our study supports CRP as a useful tool in post-operative elective colorectal care to facilitate early safe discharge.

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Cite the Article:

Kahnamoui K, Ilangomaran D, Silva S, Schroeder T, Farrokhyar F, Nalin A, et al. CARPAL: CRP to Albumin Ratio as Predictor of Anastomotic Leak. World J Surg Surgical Res. 2025; 8: 1592..