Diagnostic accuracy of procalcitonin on POD3 for the early diagnosis of anastomotic leakage after colorectal surgery: A meta-analysis and systematic review

Abstract

ObjectiveAnastomotic leakage is one of the most serious complications after colorectal surgery, and a reliable method for early diagnosis is urgently needed. Procalcitonin (PCT) is recently considered a potential biomarker by many studies, but their conclusions in detail are controversial. This meta-analysis was conducted to further explore and verify the diagnostic value of the procalcitonin level on postoperative day 3 (POD3) in patients undergoing colorectal surgery. MethodsThis review was performed using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy (PRISMA-DTA) statement. Studies were searched in PubMed, EMBASE, Cochrane Library, Wanfang, and China National Knowledge Infrastructure (CNKI) until August 2021. Quality of the studies was scored based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and a summary receiver operating characteristics (SROC) curve were used to estimate the diagnostic value. Meta-regression and subgroup analyses were performed to further explore the primary source of heterogeneity and the influence of various factors on diagnostic accuracy. ResultsEleven studies and 3393 patients were included in our meta-analysis. The derived cutoff value of PCT was 1.12 ng/ml by geometric mean and the pooled sensitivity, specificity, PLR, NLR and DOR were 0.768 (0.704–0.825), 0.788 (0.774–0.802), 4.600 (3.129–6.763), 0.339 (0.267–0.431) and 18.114 (9.872–33.239), respectively. The computed AUC from the SROC curve was 0.8714, and the Q* index was 0.8019. The results of meta-regression and subgroup analyses showed that the usage of laparoscopic surgery was the major factor in improving the reliability of PCT data, and 0.7–1.3 ng/ml may be the appropriate interval for PCT with the DOR (38.610 (16.324–91.321)) well above the average. ConclusionsThe PCT level on POD3 has potential clinical value in the early diagnosis of AL and exhibits a better diagnostic accuracy in patients undergoing laparoscopic surgery. Cut-off values are recommended at the interval range of 0.7–1.3 ng/ml to ensure accurate diagnosis and safe discharge.Research Registry Registration Number: reviewregistry 1282.