Diagnostic value of C-reactive protein and procalcitonin for postoperative pancreatic fistula following pancreatoduodenectomy: a systematic review and meta-analysis

Chen, Guo-li; Yi, Haizhao; Zhang, Jinguang

doi:10.21037/gs-21-658

Cited by 5 publications

(3 citation statements)

References 41 publications

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“…Recently, a meta-analysis carried out by van den Berg and colleagues showed a superiority of serum IL-6 within the first 72 h for the early prediction of severity of acute pancreatitis, followed by increased serum CRP levels with adequate predictive values [14]. Another systematic review and meta-analysis could show that serum CRP levels on POD 4 were highly effective (AUC of 0.86, sensitivity and specificity of 86% and 69%, respectively) in predicting pancreas-related complications following pancreas surgery [39]. Intriguingly, our current study of patients after SPKT could reveal that serum CRP levelsespecially peak serum CRP levels during the first 3 days after transplantation-are a robust predictive marker with good AUCs > 0.8 for predicting the degree and severity of ePGD.…”

Section: Discussionmentioning

confidence: 99%

“…The role of PCT and its ability to predict disease severity as well as reliable prognosis in acute pancreatitis in the non-transplant setting, is a matter of dispute [38]. So far, previous studies showed a low predictive accuracy for the severity of disease, prognostic stratification as well as (pancreas related) complications following pancreatic surgery in the setting of acute pancreatitis [9,14,16,[37][38][39]. These previous findings are in accordance with our current results in patients after SPKT, only showing a weak correlation and a low predictive accuracy of serum PCT levels in predicting ePGD-and pancreas-related complications after SPKT.…”

Section: Discussionmentioning

confidence: 99%

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Correlation of Different Serum Biomarkers with Prediction of Early Pancreatic Graft Dysfunction Following Simultaneous Pancreas and Kidney Transplantation

Jahn

Voelker

Laudi

et al. 2022

JCM

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Background: Despite recent advances and refinements in perioperative management of simultaneous pancreas–kidney transplantation (SPKT) early pancreatic graft dysfunction (ePGD) remains a critical problem with serious impairment of early and long-term graft function and outcome. Hence, we evaluated a panel of classical blood serum markers for their value in predicting early graft dysfunction in patients undergoing SPKT. Methods: From a prospectively collected database medical data of 105 patients undergoing SPKT between 1998 and 2018 at our center were retrospectively analyzed. The primary study outcome was the detection of occurrence of early pancreatic graft dysfunction (ePGD), the secondary study outcome was early renal graft dysfunction (eRGD) as well as all other outcome parameters associated with the graft function. In this context, ePGD was defined as pancreas graft-related complications including graft pancreatitis, pancreatic abscess/peritonitis, delayed graft function, graft thrombosis, bleeding, rejection and the consecutive need for re-laparotomy due to graft-related complications within 3 months. With regard to analyzing ePGD, serum levels of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), pancreatic lipase as well as neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) were measured preoperatively and at postoperative days (POD) 1, 2, 3 and 5. Further, peak serum levels of CRP and lipase during the first 72 h were evaluated. Receiver operating characteristics (ROC) curves were performed to assess their predictive value for ePGD and eRGD. Cut-off levels were calculated with the Youden index. Significant diagnostic biochemical cut-offs as well as other prognostic clinical factors were tested in a multivariate logistic regression model. Results: Of the 105 patients included, 43 patients (41%) and 28 patients (27%) developed ePGD and eRGD following SPKT, respectively. The mean WBC, PCT, NLR, PLR, CRP and lipase levels were significantly higher on most PODs in the ePGD group compared to the non-ePGD group. ROC analysis indicated that peak lipase (AUC: 0.82) and peak CRP levels (AUC: 0.89) were highly predictive for ePGD after SPKT. The combination of both achieved the highest AUC (0.92; p < 0.01) in predicting ePGD. Concerning eRGD, predictive accuracy of all analyzed serological markers was moderate (all AUC < 0.8). Additionally, multivariable analysis identified previous dialysis/no preemptive transplantation (OR 2.4 (95% CI: 1.41–4.01), p = 0.021), donor age (OR 1.07 (95% CI: 1.03–1.14), p < 0.010), donor body mass index (OR 1.32 (95% CI: 1.01–1.072), p = 0.04), donors cerebrovascular cause of death (OR 7.8 (95% CI: 2.21–26.9), p < 0.010), donor length of ICU stay (OR 1.27 (95% CI: 1.08–1.49), p < 0.010), as well as CIT pancreas (OR 1.07 (95% CI: 1.03–1.14), p < 0.010) as clinical relevant prognostic predictors for ePGD. Further, a peak of lipase (OR 1.04 (95% CI: 1.02–1.07), p < 0.010), peak of CRP levels (OR 1.12 (95% CI: 1.02–1.23), p < 0.010), pancreatic serum lipase concentration on POD 2 > 150 IU/L (OR 2.9 (95% CI: 1.2–7.13), p = 0.021) and CRP levels of ≥ 180 ng/mL on POD 2 (OR 3.6 (95% CI: 1.54–8.34), p < 0.01) and CRP levels > 150 ng/mL on POD 3 (OR 4.5 (95% CI: 1.7–11.4), p < 0.01) were revealed as independent biochemical predictive variables for ePGD after transplantation. Conclusions: In the current study, the combination of peak lipase and CRP levels were highly effective in predicting early pancreatic graft dysfunction development following SPKT. In contrast, for early renal graft dysfunction the predictive value of this parameter was less sensitive. Intensified monitoring of these parameters may be helpful for identifying patients at a higher risk of pancreatic ischemia reperfusion injury and various IRI- associated postoperative complications leading to ePGD and thus deteriorated outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Correlation of Different Serum Biomarkers with Prediction of Early Pancreatic Graft Dysfunction Following Simultaneous Pancreas and Kidney Transplantation

Jahn

Voelker

Laudi

et al. 2022

JCM

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“…Risk factors for CR-POPF include residual pancreatic texture, pancreatic duct diameter, BMI, drainage tube amylase level, CRP, procalcitonin, CAR (CRP/ALB), and postoperative lactic acid level [4][5][6][7][8][9][10]. Subjective awareness is a big part of guring out the texture of the residual pancreas.…”

Section: Introductionmentioning

confidence: 99%

Total bilirubin level on postoperative day 3 in predicting clinically relevant pancreatic fistula after pancreaticoduodenectomy : a retrospective study

Wang,

Qin,

Zhang

et al. 2024

Preprint

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Background: The prevalence of clinically relevant postoperative pancreatic fistulas (CR-POPF) following pancreaticoduodenectomy (PD) is relatively high. Most studies on the prediction of CR-POPF are limited to pre-operation, while there are few indicators to predict CR-POPF in the early postoperative period. The purpose of this study was to investigate the value of total bilirubin (TBIL) level on postoperative day 3 in predicting CR-POPF after PD. Methods: The clinical data of 170 patients who underwent PD in our team from January 2015 to October 2022 was retrospectively analyzed into two groups: the CR-POPF group with a grade B or C pancreatic fistula (n = 37), the no CR-POPF group with a non-pancreatic fistula, and the biochemical fistula patients (n = 133). Univariate and multivariate analyses were used to screen the potential indicators for predicting CR-POPF. The predictive value of risk factors was assessed by area under the ROC curve. Results: Preoperative variables, including hemoglobin (Hb), C-reactive protein (CRP), TBIL, albumin (ALB), pancreatic texture, hemorrhage, duct diameter, and TBIL on postoperative day 3, were identified as predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) (p < 0.001). The multivariate logistic regression analysis revealed that pancreatic texture (p = 0.004), postoperative TBIL (p<0.001), and preoperative CRP (p = 0.048) were identified as independent risk variables. To predict CR-POPF, the area under the curve (AUC) of pancreatic texture, TBIL on the third day of surgery, and preoperative CRP were found to be 0.607, 0.824, and 0.726, respectively. Conclusion: The TBIL level on postoperative day 3 is a significant predictor of CR-POPF after PD which can accurately predict CR-POPF.

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The role of clinically relevant intra-abdominal collections after pancreaticoduodenectomy

Lopez,

Pando,

Ortega-Torrecilla

et al. 2023

Langenbecks Arch Surg

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Background There is controversial evidence regarding the impact of clinically relevant postoperative intra-abdominal collections (CR-IC) on the clinical course after pancreaticoduodenectomy. C-reactive Protein (CRP) has been validated as a predictor of postoperative pancreatic fistula (POPF). Still, its role in predicting CR-IC has not been studied. Methods A retrospective analysis was conducted on patients who underwent PD at a tertiary hospital between October 2012 and October 2017. The incidence of CR-IC, clinically relevant POPF and other complications, as well as mortality and length of hospitalisation, was retrieved. The impact of CR-IR on mortality and major complications was analysed. The serum CRP levels were retrieved on the third and fifth postoperative days (POD3 and POD5), followed by an analysis of sensitivity, specificity, and area under the curve to predict CR-IC using CRP. Results One hundred forty patients were enrolled following inclusion and exclusion criteria. The mean age was 66.5 years (15–83). The incidence of CR-IC was 33.7% (47), and CR-POPF was 24.3%. Pancreatic duct diameter ≤ 4 mm was identified as a risk factor related to CR-IC occurrence. The group of patients who developed CR-IC after PD exhibited a higher rate of complications Clavien-Dindo ≥ III compared to patients without CR-IC (40.4% vs 7.5%, p < 0.001), as well as other events such as admission to the intensive care unit (25.5% vs 4.3%, p < 0.001), the incidence of CR-POPF (66% vs 3.2%, p < 0.001), prolonged hospital stay (32 vs 13 days, p < 0.001), postoperative haemorrhage (23.4 vs 5.4%, p = 0.002), and delayed gastric empty (38.8% vs 11.8%, p < 0.001) respectively. Logistic regression analysis identified CR-IC related to POPF as a risk factor for Clavien-Dindo > III: OR = 10.6 (95% CI: 3.90–28.7). No differences in mortality were reported between the CR-IC group and non-CR-IC group. CRP at postoperative day 3 (POD3) > 17.55 mg/dl and CRP at postoperative day 5 (POD5) > 13.46 mg/dl were predictors of CR-IC (AUC: 0.731 and AUC:0.821, respectively). Conclusions CR-IC has a significant impact after pancreaticoduodenectomy and is associated with a higher incidence of Clavien-Dindo ≥ III complications. Additionally, CRP levels at POD3 and POD5 play a role in predicting CR-IC. Prospective studies are essential to explore strategies for mitigating the occurrence of CR-IC after PD.

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Diagnostic value of C-reactive protein and procalcitonin for postoperative pancreatic fistula following pancreatoduodenectomy: a systematic review and meta-analysis

Cited by 5 publications

References 41 publications

Correlation of Different Serum Biomarkers with Prediction of Early Pancreatic Graft Dysfunction Following Simultaneous Pancreas and Kidney Transplantation

Correlation of Different Serum Biomarkers with Prediction of Early Pancreatic Graft Dysfunction Following Simultaneous Pancreas and Kidney Transplantation

Total bilirubin level on postoperative day 3 in predicting clinically relevant pancreatic fistula after pancreaticoduodenectomy : a retrospective study

The role of clinically relevant intra-abdominal collections after pancreaticoduodenectomy

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