Association of Serum Endocan, Procalcitonin, and C-Reactive Protein with Early Postoperative Infectious Complications Following Colorectal Surgery

Background: Early postoperative infections after colorectal surgery remain challenging; serum endocan, procalcitonin, and C-reactive protein may facilitate timely risk-identification strategies. Aims of the study: This study aimed to evaluate the associations of perioperative serum endocan, procalcitonin, and C-reactive protein with early infectious complications following colorectal surgery and compare their diagnostic performan. Methodology: This prospective cohort study included 180 adults undergoing colorectal surgery at Al-Nasiriyah General Hospital and affiliated clinics between April 10, 2025, and June 2, 2026. Participants were followed for 30 days; 34 developed infectious complications and 146 remained uncomplicated. Serum samples were collected preoperatively and on postoperative days 1 and 3. Endocan, procalcitonin, and CRP were measured using sandwich ELISA. Complications were diagnosed using clinical, microbiological, laboratory, and imaging criteria. Ethical approval and written informed consent were obtained. Result: Among 180 patients, 34 (18.9%) developed infectious complications, most commonly surgical-site infection (12.8%). Infected patients had more diabetes, open procedures, longer operations, greater blood loss, and prolonged hospitalization. Postoperative endocan, procalcitonin, and CRP were significantly elevated, particularly on day 3. Procalcitonin showed the strongest individual discrimination (AUC=0.87), followed by endocan (AUC=0.84). Both remained independent predictors after adjustment. The combined clinical–biomarker model achieved an AUC of 0.89, with 82.4% sensitivity and 84.2% specificity. Conclusions: Serial endocan and procalcitonin measurements were independently associated with early infectious complications after colorectal surgery. Their integration with clinical factors improved diagnostic performance, supporting multimarker-guided postoperative surveillance; however, the proposed model and cutoff values require validation in larger multicenter cohorts