The Role of C-reactive Protein and Procalcitonin in Predicting the Occurrence of Pancreatic Fistula in Patients who Underwent Laparoscopic Pancreaticoduodenectomy: a Retrospective Study

Abstract

Background

The occurrence of postoperative pancreatic fistula following laparoscopic pancreaticoduodenectomy (LPD) is a significant concern, yet there is currently a lack of consensus on reliable predictive methods for this complication. Therefore, the aim of this study was to assess the clinical significance of C-reactive protein (CRP) and procalcitonin (PCT) values and their reliability in early predicting the development of clinically relevant pancreatic fistula (CRPF) following LPD.

Methods

A retrospective analysis was conducted using data from 120 patients who had LPD between September 2019 and December 2021. Preoperative assessment data, standard patients’ demographic and clinicopathological characteristics, intra- and postoperative evaluation, as well as postoperative laboratory values on postoperative days (PODs) 1, 3, and 7, including white blood cells (WBCs), CRP, and PCT, were prospectively recorded on a dedicated database. Two clinicians separately collected and cross-checked all of the data.

Results

Among 120 patients [77 men (64%), 43 women (36%], CRPF occurred in 15 patients (11 grade B and 4 grade C fistulas). The incidence rate of CRPF was 12.3%. A comparison of the median values of WBCs, PCT, and CRP across the two groups revealed that the CRPF group had higher values on most PODs than the non-CRPF group. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) and cutoff values. It was discovered that POD 3 has the most accurate and significant values for WBCs, CRP, and PCT. According to the ROC plots, the AUC for WBCs was 0.842, whereas the AUC for PCT was 0.909. As for CRP, the AUC was 0.941 (95% CI 0.899–0.983, p < 0.01) with a cutoff value of 203.45, indicating a sensitivity of 93.3% and specificity of 91.4%.

Conclusion

Both CRP and PCT can be used to predict the early onset of CRPF following LPD, with CRP being slightly superior on POD 3.

Zusammenfassung

Hintergrund

Das Auftreten einer postoperativen Pankreasfistel nach einer laparoskopischen Pankreatikoduodenektomie (LPD) ist ein erhebliches Problem. Dennoch besteht derzeit kein Konsens über zuverlässige Vorhersagemethoden für diese Komplikation. Ziel dieser Studie war es, die klinische Bedeutung der Werte von C-reaktivem Protein (CRP) und Procalcitonin (PCT) und ihre Zuverlässigkeit bei der frühzeitigen Vorhersage der Entwicklung einer klinisch relevanten Pankreasfistel (CRPF) nach einer LPD zu bewerten.

Methoden

Eine retrospektive Analyse wurde mit Daten von 120 Patienten durchgeführt, die sich zwischen September 2019 und Dezember 2021 einer LPD unterzogen hatten. Präoperative Beurteilungsdaten, demografische und klinisch-pathologische Merkmale von Standardpatienten, intra- und postoperative Bewertung sowie postoperative Laborwerte an postoperativen Tagen (PODs) 1, 3 und 7 einschließlich weißer Blutkörperchen (WBCs), CRP und PCT, wurden prospektiv in einer speziellen Datenbank erfasst. Die Daten wurden von 2 Klinikern, unabhängig voneinander, gesammelt und überprüft.

Ergebnisse

Unter 120 Patienten (77 Männer [64%], 43 Frauen [36%]) trat CRPF bei 15 Patienten auf (11 Fisteln vom Grad B und 4 Fisteln vom Grad C). Die Inzidenzrate von CRPF betrug 12,3%. Ein Vergleich der Medianwerte von WBCs, PCT und CRP in den beiden Gruppen zeigte, dass die CRPF-Gruppe bei den meisten PODs höhere Werte aufwies als die Nicht-CRPF-Gruppe. Zur Berechnung der Fläche unter der Kurve (AUC) und der Grenzwerte wurde eine ROC-Analyse (Receiver Operating Characteristic) angewandt. Es wurde festgestellt, dass POD 3 die genauesten und signifikantesten Werte für Leukozyten, CRP und PCT aufweist. Den ROC-Diagrammen zufolge betrug die AUC für Leukozyten 0,842, während die AUC für PCT 0,909 betrug. Für CRP war die AUC gleich 0,941 (95%-KI 0,899–0,983, p < 0,01) mit einem Cut-off-Wert von 203,45, was einer Sensitivität von 93,3% und einer Spezifität von 91,4% entspricht.

Schlussfolgerung

Sowohl CRP als auch PCT können verwendet werden, um das frühe Einsetzen von CRPF nach LPD vorherzusagen, wobei CRP am POD 3 leicht überlegen ist.

Keywords

laparoscopic pancreaticoduodenectomy - pancreatic fistula - C-reactive protein - Procalcitonin

Schlüsselwörter

laparoskopische Pankreas-Duodenektomie - Pankreasfistel - C-reaktives Protein - Procalcitonin

Publication History

Received: 27 March 2023

Accepted after revision: 21 August 2023

Article published online:
05 October 2023

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