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20.05.2016 | Original Article | Ausgabe 8/2016

Journal of Gastrointestinal Surgery 8/2016

C-Reactive Protein and Procalcitonin as Predictors of Postoperative Inflammatory Complications After Pancreatic Surgery

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 8/2016
Autoren:
A. Giardino, G. Spolverato, P. Regi, I. Frigerio, F. Scopelliti, R. Girelli, Z. Pawlik, P. Pederzoli, C. Bassi, G. Butturini
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11605-016-3171-6) contains supplementary material, which is available to authorized users.

Synopsis

C-reactive protein (CRP) and procalcitonin (PCT), especially in the early postoperative period, were strongly correlated to a higher risk of complications and clinically relevant pancreatic fistula after pancreaticoduodenectomy (PD). The use of CRP and PCT may help direct the postoperative management of patients undergoing PD.

Abstract

Background

The association between postoperative inflammatory markers and risk of complications after pancreaticoduodenectomy (PD) is controversial. We sought to assess the diagnostic value of perioperative C-reactive protein (CRP) and procalcitonin (PCT) levels in the early identification of patients at risk for complications after PD.

Methods

In 2014, 84 patients undergoing elective PD were enrolled in a prospective database. Clinicopathological characteristics, CRP and PCT, as well as short-term outcomes, such as complications and pancreatic fistula, were analyzed. Complications and pancreatic fistula were defined based on the Clavien-Dindo classification and the International Study Group on Pancreatic Fistula (ISGPF) classification, respectively. High CRP and PCT were classified using cut-off values based on ROC curve analysis.

Results

The majority (73.8 %) of patients had pancreatic adenocarcinoma. CRP and PCT levels over the first 5 postoperative days (POD) were higher among patients who experienced a complication versus those who did not (p < 0.001). Postoperative CRP and PCT levels were also higher among patients who developed a grade B or C pancreatic fistula (p < 0.05). A CRP concentration >84 mg/l on POD 1 (AUC 0.77) and >127 mg/l on POD 3 (AUC 0.79) was associated with the highest risk of overall complications (OR 6.86 and 9.0, respectively; both p < 0.001). Similarly patients with PCT >0.7 mg/dl on POD 1 (AUC 0.67) were at higher risk of developing a postoperative complication (OR 3.33; p = 0.024). On POD 1, a CRP >92 mg/l (AUC 0.72) and a PCT >0.4 mg/dl (AUC 0.70) were associated with the highest risk of pancreatic fistula (OR 5.63 and 5.62, respectively; both p < 0.05).

Conclusions

CRP and PCT concentration were associated with an increased risk of developing complications and clinical relevant pancreatic fistula after PD. Use of these biomarkers may help identify those patients at highest risk for perioperative morbidity and help guide postoperative management of patients undergoing PD.

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Zusatzmaterial
ESM 1 (DOCX 20 kb)
11605_2016_3171_MOESM1_ESM.docx
Literatur
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