Diagnostic accuracy of urinary intestinal fatty acid-binding protein in detecting colorectal anastomotic leakage
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Diagnostic accuracy of urinary intestinal fatty acid‑binding protein in detecting colorectal anastomotic leakage S. Sabour1,2 Received: 18 April 2020 / Accepted: 8 May 2020 © Springer Nature Switzerland AG 2020
Dear Sir, I read with interest the paper by Plat and colleagues that was published in the May 2020 edition of Techniques in Coloproctology [1]. Anastomotic leakage (AL) remains a severe complication following colorectal surgery, having a negative impact on both short- and long-term outcomes. Since timely detection could enable early intervention, there is a need for the development of novel and accurate, preferably, noninvasive markers. The authors aimed to investigate whether urinary intestinal fatty acid-binding protein (I-FABP) could serve as such a marker. Urine samples of 15 patients with confirmed colorectal AL and 19 patients without colorectal AL on postoperative day 3 were included. Urinary I-FABP levels were determined using enzyme-linked immunosorbent assays and adjusted for urinary creatinine to compensate for renal dysfunction. Plat et al. reported that urinary I-FABP levels were significantly elevated in patients with confirmed AL compared to patients without AL on postoperative day 3 (median 2.57 ng/ml vs 0.81 ng/ml, p = 0.006). The area under the receiver operating characteristics curve (AUROC) was 0.77, yielding a sensitivity of 80% and specificity of 74% at the optimal cutoff point (> 1.589 ng/ml). Though the article shows that levels of urinary I-FABP were significantly elevated in patients with confirmed AL following colorectal surgery, suggesting its potential as a non-invasive biomarker for colorectal anastomotic leakage, it is important to keep in mind that sensitivity, specificity, predictive values, likelihood ratios and AUROC do * S. Sabour [email protected] 1
Department of Clinical Epidemiology, School of Health and Safety, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak, Daneshjoo Blvd, Tehran 198353‑5511, Islamic Republic of Iran
Safety Promotions and Injury Prevention Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
2
not provide information about the importance of I-FABP in clinical practice. Actually, when comparing these estimates as in table 3 of the paper, you might have difficulty choosing between I-FABP and I-FABP/creatinine as an accurate marker. For clinical purposes, the diagnostic added value is much more important than the reported estimates. Accuracy estimates can be acceptable yet diagnostic added value may be negligible [2–5]. Diagnostic knowledge is not provided by answering the question, “How accurate is this test?” Diagnostic knowledge is the information needed to answer the question, “What is the probability of the presence or absence of a specific disease given these test results?” It is crucial to know that many published diagnostic studies are better characterized as test accuracy research than as diagnostic accuracy research. The objective of test resea
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