Anastomotic leakage is a dreaded postoperative complication in patients who have undergone colorectal surgery. A systematic review and meta-analysis was conducted to explore the utility of procalcitonin in the diagnosis of anastomotic leakage on the third postoperative day. PubMed, EMBASE, Cochrane Library, Wanfang, and China National Knowledge Infrastructure (CNKI) were searched for suitable trials until August 2021 and 11 studies involving 3393 patients were included in the meta-analysis. 

Using geometric mean, the cut-off value of procalcitonin obtained was 1.12 ng/ml; the positive likelihood ratio was 4.600, negative likelihood ratio was 0.339 and the diagnostic odds ratio was 18.114. the pooled sensitivity was 0.768 and specificity was 0.788. The key factor improving the reliability of procalcitonin on meta-regression and subgroup analyses was laparoscopic surgery. The appropriate range for procalcitonin appeared to be 0.7-1.3 ng/ml with diagnostic odds ratio of 38.610. Hence, according to this meta-analysis, procalcitonin levels on the third postoperative day may serve as useful biomarkers for early diagnosis of anastomotic leakage in patients undergoing laparoscopic surgery. The study authors recommend the interval range of 0.7-1.3 ng/ml to improve diagnostic accuracy and safe discharge.

Zhengao Xu, et al. Int J Surg. 2022 Apr;100:106592.