C-Reactive Protein Trends and Prediction of Anastomotic Leak in Esophageal Atresia
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Abstract
Objective: C-reactive protein (CRP), an acute phase reactant, has been proposed as an early biomarker for anastomotic leak in such patients. Design: Retrospective, single center, observational study. Patients: A cohort of 202 postoperative patients, with serum CRP levels measured on postoperative day (POD) 1, 3, and 5. Methods: Patients were stratified according to the presence of anastomotic leak (n=41) versus no leak (n=161). Group differences were assessed, and analysis was performed to evaluate diagnostic accuracy and determine optimal cutoff values. Result: Mean CRP levels were significantly higher in patients with anastomotic leaks compared to those without, with differences becoming most pronounced after POD 3. Statistical testing confirmed significant differences at POD 1 (p<0.01), POD 3 (p<1×10⁻⁹), and POD 5 (p<1×10⁻¹⁵). ROC analysis demonstrated increasing discriminatory power across time points: AUC 0.64 (POD1), 0.85 (POD3), and 0.94 (POD5). Optimal CRP cutoffs were identified as 2.7 mg/dl (POD1, sensitivity 61%, specificity 70%), 6.7 mg/dl (POD3, sensitivity 68%, specificity 89%), and 7.5 mg/dl (POD5, sensitivity 93%, specificity 98%). Conclusion: Elevated postoperative CRP levels, particularly on POD3 and POD5, are strongly associated with the occurrence of anastomotic leak. A CRP threshold of approximately 7 mg/dl on POD3 may serve as an early warning indicator, while levels above 7.5 mg/dl on POD5 provide excellent diagnostic accuracy. Routine CRP monitoring can therefore facilitate earlier detection and timely intervention in patients with anastomotic complications.
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Copyright (c) 2025 Dr. Ashish Paliwal, Dr. Vinita Chaturvedi, Dr. Neeraj Tuteja, Dr. Ajay Jhalani, Dr. Aditya J Baindur, Dr. Ashok Chopra, Dr. Pankaj Goyal, Dr. Atul Kumar Khare
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Dr. Ashish Paliwal, MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Dr. Vinita Chaturvedi, Senior Professor and Head of Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Senior Professor and Head of Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Dr. Neeraj Tuteja, Associate Professor, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Associate Professor, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Dr. Ajay Jhalani, Assistant Professor, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Assistant Professor, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Dr. Aditya J Baindur, MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Dr. Ashok Chopra, MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Dr. Pankaj Goyal, MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
Dr. Atul Kumar Khare, MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
MCH Resident, Department of Pediatrics Surgery, Sawai Man Singh, Medical College and Hospital, Jaipur, Rajasthan.
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