Role of Serum C-Reactive Protein, Interleukin-6, Leukocyte Indices, and Serum Albumin as Predictors of Anastomotic Leak in Colorectal Surgery: A Pilot Study from India

Background: Anastomotic leak (AL) following colorectal surgery can lead to significant morbidity andmortality, with an incidence ranging from 2% to 14%. Early diagnosis and management are crucial forimproving patient outcomes. However, the clinical detection of leaks is often delayed, adversely affecting theseoutcomes. Therefore, there is a pressing need for serum markers that can serve as diagnostic tools prior to theonset of clinical manifestations. The objective of this study is to investigate the changes in serum C-reactiveprotein (CRP), albumin, leukocyte indices, and interleukin-6 (IL-6), and to access their association with AL incolorectal anastomosis.Methods: This prospective observational pilot study included 30 patients undergoing elective colorectal resectionand anastomosis for both benign and malignant conditions at the Department of Surgical Gastroenterology,SGPGIMS Lucknow, a tertiary care teaching hospital in northern India, from April 2021 to March 2022.Serum C-reactive protein (CRP), albumin, total leukocyte count (TLC), complete blood counts, platelet count,and IL-6 levels were measured preoperatively and postoperatively. Patients were divided into two groups:Group 1, which experienced anastomotic leaks, and Group 2, which did not. Changes in these markers werecompared preoperatively and on postoperative days (POD) 1, 3, and 7. To compare the changes between groups,the Mann–Whitney U test was utilized, and multivariate analysis was conducted to identify predictors ofanastomotic leaks using Firth logistic regression. A P value of <0.05 was considered statistically significant.Results: Group 1 comprised 4 patients (13.3%), while Group 2 included 26 patients (86.7%). A statisticallysignificant difference was observed in serum CRP levels (P=0.001), neutrophil-to-lymphocyte ratio (NLR)(P=0.009), and serum IL-6 levels (P=0.03) on POD 3 between group 1 and group 2. In the multivariate analysisutilizing Firth logistic regression, serum CRP exhibited OR=1.09 and NLR demonstrated OR=1.28.Conclusion: A significant increase in serum CRP, NLR, and IL6 on POD 3 may serve as valuable markers forthe early detection of AL.