Giardino A, Spolverato G, Regi P, Frigerio I, Scopelliti F, Girelli R, Pawlik Z, Pederzoli P, Bassi C, Butturini G
Hepato-Pancreato-Biliary Surgery Unit, Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, VR, Italy.
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Gastrointest Surg. 2016 Aug;20(8):1482-92. doi: 10.1007/s11605-016-3171-6. Epub 2016 May 20.
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.
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.
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).
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.
胰十二指肠切除术（PD）后炎症标志物与并发症风险之间的关联存在争议。我们旨在评估围手术期C反应蛋白（CRP）和降钙素原（PCT）水平在早期识别PD术后并发症风险患者中的诊断价值。
2014年，84例行择期PD的患者被纳入前瞻性数据库。分析临床病理特征、CRP和PCT以及短期结局，如并发症和胰瘘。并发症和胰瘘分别根据Clavien-Dindo分类和国际胰瘘研究组（ISGPF）分类进行定义。基于ROC曲线分析使用临界值对高CRP和PCT进行分类。
大多数（73.8%）患者患有胰腺腺癌。术后第1至5天（POD）出现并发症的患者的CRP和PCT水平高于未出现并发症的患者（p<0.001）。发生B级或C级胰瘘的患者术后CRP和PCT水平也更高（p<0.05）。POD 1时CRP浓度>84 mg/l（AUC 0.77）和POD 3时>127 mg/l（AUC 0.79）与总体并发症风险最高相关（OR分别为6.86和9.0；均p<0.001）。同样，POD 1时PCT>0.7 mg/dl（AUC 0.67）的患者发生术后并发症的风险更高（OR 3.33；p=0.024）。在POD 1时，CRP>92 mg/l（AUC 0.72）和PCT>0.4 mg/dl（AUC 0.70）与胰瘘风险最高相关（OR分别为5.63和5.62；均p<0.05）。
CRP和PCT浓度与PD术后发生并发症和临床相关胰瘘的风险增加相关。使用这些生物标志物可能有助于识别围手术期发病率风险最高的患者，并有助于指导PD患者的术后管理。
