Plat, V. D., Bootsma, B. T., Neal, Matthew, Nielsen, K., Sonneveld, D. J. A., Tersteeg, J. J. C., Crolla, R. M. P. H., van Dam, D. A., Cense, H. A., Stockmann, H. B. A. C., Covington, James A., de Meij, T. G. J., Tuynman, J. B., de Boer, N. K. H. and Daams, F. (2019) Urinary volatile organic compound markers and colorectal anastomotic leakage. Colorectal Disease . doi:10.1111/codi.14732 (In Press)

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Abstract

Aim:
Inflammatory markers such as serum C‐reactive protein (CRP) are used as routine markers to detect anastomotic leakage following colorectal surgery. However, CRP is characterized by a relatively low predictive value, emphasizing the need for the development of novel diagnostic approaches. Volatile organic compounds (VOCs) are gaseous metabolic products deriving from all conceivable bodily excrements and reflect (alterations in) the patient's physical status. Therefore, VOCs are increasingly considered as potential non‐invasive diagnostic biomarkers. The aim of this study was to assess the diagnostic accuracy of urinary VOCs for colorectal anastomotic leakage.

Methods:
In this explorative multicentre study, urinary VOC profiles of 22 patients with confirmed anastomotic leakage and 27 uneventful control patients following colorectal surgery were analysed by field asymmetric ion mobility spectrometry (FAIMS).

Results:
Urinary VOCs of patients with anastomotic leakage could be distinguished from those of control patients with high accuracy: area under the receiver operating characteristics curve 0.91 (95% CI 0.81–1.00, P < 0.001), sensitivity 86% and specificity 93%. Serum CRP was significantly increased in patients with a confirmed anastomotic leak but with lower diagnostic accuracy compared to VOC analysis (area under the receiver operating characteristics curve 0.82, 95% CI 0.68–0.95, P < 0.001). Combining VOCs and CRP did not result in a significant improvement of the diagnostic performance compared to VOCs alone.

Conclusion:
Analysis by FAIMS allowed for discrimination between urinary VOC profiles of patients with a confirmed anastomotic leak and control patients following colorectal surgery. A superior accuracy compared to CRP and apparently high specificity was observed, underlining the potential as a non‐invasive biomarker for the detection of colorectal anastomotic leakage.

Item Type:	Journal Article
Subjects:	Q Science > QD Chemistry R Medicine > RD Surgery
Divisions:	Faculty of Science > Engineering Faculty of Science > Statistics
Library of Congress Subject Headings (LCSH):	Colon (Anatomy) -- Surgery, Rectum -- Surgery, Volatile organic compounds, Ion mobility spectroscopy
Journal or Publication Title:	Colorectal Disease
Publisher:	Wiley-Blackwell Publishing, Inc.
ISSN:	1462-8910
Official Date:	17 June 2019
Dates:	Date Event 17 June 2019 Available 15 June 2019 Accepted
Date of first compliant deposit:	6 August 2019
DOI:	10.1111/codi.14732
Status:	Peer Reviewed
Publication Status:	In Press
Publisher Statement:	This is the peer reviewed version of the following article: Plat, V. D., Bootsma, B. T., Neal, M. , Nielsen, K. , Sonneveld, D. J., Tersteeg, J. J., Crolla, R. M., van Dam, D. A., Cense, H. A., Stockmann, H. B., Covington, J. A., de Meij, T. G., Tuynman, J. B., de Boer, N. K. and Daams, F. (2019), Urinary volatile organic compound markers and colorectal anastomotic leakage. Colorectal Dis. doi:10.1111/codi.14732, which has been published in final form at https://doi.org/10.1111/codi.14732. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Access rights to Published version:	Restricted or Subscription Access

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