Monocytic HLA-DR Expression for Prediction of Anastomotic Leak after Colorectal Surgery

J Am Coll Surg. 2019 Aug;229(2):200-209. doi: 10.1016/j.jamcollsurg.2019.03.010. Epub 2019 Mar 22.


Background: Earlier detection of anastomotic leakage (AL) after colorectal procedures could minimize the detrimental clinical impact of AL and thereby reduce morbidity and mortality.

Study design: We conducted a prospective study with assessment of the diagnostic accuracy of monocytic HLA-DR (mHLA-DR) expression compared with WBCs, C-reactive protein (CRP), and procalcitonin (PCT) in predicting AL in patients undergoing elective colorectal operation with anastomosis.

Results: Comparison of the blood marker values on postoperative day (POD) 4 revealed significant differences for all markers, but the difference for mHLA-DR was highly significant (15% expression of monocytes in AL patients vs 34% in patients without AL; p = 0.001). Together with WBC (p = 0.026), mHLA-DR expression was the only test to show significance on day 3 (14% vs 31%; p < 0.001). Receiver operating characteristic analysis revealed that mHLA-DR expression had superior diagnostic accuracy compared with all other diagnostic markers both on POD 3 (mHLA-DR area under the curve [AUC] 0.928; WBC AUC 0.734; CRP AUC 0.707; PCT AUC 0.672) and POD 4 (mHLA-DR AUC 0.887; WBC AUC 0.738; CRP AUC 0.709; PCT AUC 0.696). Monocytic HLA-DR had a negative predictive value of at least 94% on PODs 3 and 4, as well as specificity and positive predictive values of 100% at a threshold of 23% on POD 3 and 24% on POD 4, respectively.

Conclusions: Expression of mHLA-DR appears to be a more accurate predictor for AL after colorectal operation compared with WBC, CRP, and PCT. It represents a promising test to precisely monitor the perioperative course of high-risk patients and contribute to safer discharge.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical
  • Anastomotic Leak / blood
  • Anastomotic Leak / diagnosis*
  • Biomarkers / blood
  • Colon / surgery*
  • Female
  • Follow-Up Studies
  • HLA-DR Antigens / blood*
  • Humans
  • Male
  • Middle Aged
  • Monocytes / metabolism*
  • Pilot Projects
  • Prospective Studies
  • Rectum / surgery*
  • Sensitivity and Specificity
  • Young Adult


  • Biomarkers
  • HLA-DR Antigens