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Abstract

Background: Infectious complications remain a major clinical problem in colorectal surgery, contributing
to prolonged hospital stays, additional costs and significant postoperative mortality. Presepsin has been
reported to be a useful marker to diagnose sepsis, similar or superior to procalcitonin (PCT) and Creactive
protein (CRP), and plasma presepsin concentrations are associated with the severity of sepsis
and its outcome. The aim of this study was to assess the diagnostic value of presepsin in the early
detection of infectious complications after elective colorectal surgery, compared with CRP and PCT.

Methods: This study was a prospective observational study. Patients of age >18 who underwent elective
colon resections were enrolled and patients with end-stage kidney disease were excluded. Blood samples
were collected just before surgery and on postoperative day (POD) 1, 2, 3, 4, and 6. Infectious
complications were diagnosed by surgeons.

Results: A total of 114 patients were examined, and 27 patients (23.7%) developed infectious
complications: 11 anastomotic leaks, 13 intra-abdominal infections, and 3 wound infections. CRP and
PCT markedly increased from POD1 to POD3 and then gradually decreased toward POD6 in both groups,
but the trends of the decrease in the infected group were blunt, compared with those in the non-infected
group. On the other hand, presepsin did not show major changes just after surgery, but it increased on
POD4 and POD6, when the complications occurred. ROC analysis to predict infectious complications
revealed that the best accuracy was obtained on POD 6 for all biomarkers. CRP showed excellent
predictability and presepsin showed good predictability. However, the cut-off values of all biomarkers
were relatively lower than expected.

Conclusions: The trends of change in presepsin following colorectal surgeries were distinct from those of
CRP and PCT. Monitoring the presepsin trends after colorectal surgeries could be helpful to detect
postoperative infectious complications.

Keywords: presepsin, infectious complications, colorectal surgery