Preoperative C-Reactive Protein-to-Albumin Ratio Predicts Postoperative Pancreatic Fistula following Pancreatoduodenectomy: A Single-Center, Retrospective Study

Abstract

Postoperative pancreatic fistula (POPF) following pancreatoduodenectomy (PD) is a potentially lethal complication, and it is clinically important to determine its risk preoperatively. Although C-reactive protein-to-albumin ratio (CAR) is reported to be a prognostic marker for postoperative complications in several cancers, no evidence is currently available regarding the association between preoperative CAR and POPF following PD for periampullary tumors. This study examined whether preoperative CAR could predict POPF following PD. Clinical data were retrospectively retrieved from Ehime University Hospital. The optimal cut-off value for CAR was determined using receiver operating characteristic (ROC) curve analysis. This study enrolled 203 consecutive patients undergoing PD for periampullary tumors. The CAR value was significantly higher in the POPF group than in the non-POPF group (p < 0.001). According to the ROC curve analysis, the optimal cut-off value for CAR was 0.09. Patients with CAR ≥ 0.09 had higher incidence rates of POPF than their counterparts. CAR ≥ 0.09 was a risk factor for POPF in the multivariate logistic regression analysis (odds ratio 34.5, 95% confidence interval 11.75–101.38, p < 0.001). This is the first report demonstrating an association between CAR and POPF following PD. Preoperative CAR is an independent predictive marker for POPF following PD.

C-Reactive Protein-to-Albumin Ratio to Predict Tolerability of S-1 as an Adjuvant Chemotherapy in Pancreatic Cancer

“…Therefore, we assumed that indicators encompassing both the nutritional status and inflammatory conditions would be more promising. Various indicators, including the lymphocyte-to-CRP ratio [ 34 ], platelet-to-albumin ratio [ 35 ], neutrophil-to-lymphocyte ratio [ 36 , 37 ], platelet-to-lymphocyte ratio [ 38 ], prognostic nutritional index [ 39 , 40 ], and CAR [ 41 , 42 ], which take into account both inflammation and nutritional status, have been identified as predictors of prognosis or POCs. Among these indicators, the identification of one as a useful prognostic marker may also allow us to predict the S-1 completion rates for AC, which are correlated with better prognosis in PC patients.…”

“…According to a large-scale study, patients who experienced severe POCs, specifically those with a CD grade ≥3, were reported to initiate AC less frequently after pancreatic surgery [ 50 ]. Furthermore, it has been demonstrated that CAR serves as a valuable predictor of POCs following pancreatic resection [ 41 , 42 ]. CAR, a straightforward metric calculated solely through blood tests, has been underscored as a prognostic factor for PC patients.…”

C-reactive Protein-to-Albumin Ratio: A Useful Predictor for Biliary Fistula After Hepatectomy

“…CAR was estimated using preoperative CRP and serum albumin values. These data were obtained preoperatively and calculated using the following formula: CAR = CRP (mg/dL) / Serum albumin (g/dL) [ 9 ].…”