Hiraki Masatsugu, Miyoshi Atsushi, Sadashima Eiji, Shinkai Yukio, Yasunami Michio, Manabe Tatsuya, Kitahara Kenji, Noshiro Hirokazu
Department of Surgery, Saga Medical Center Koseikan, Saga 840-8571, Japan.
Life Science Research Institution, Saga Medical Center Koseikan, Saga 840-8571, Japan.
Exp Ther Med. 2020 Sep;20(3):2298-2304. doi: 10.3892/etm.2020.8919. Epub 2020 Jun 19.
Postoperative pancreatic fistula (PF) is a major and serious complication that occurs after pancreaticoduodenectomy (PD). The aim of the current study was to evaluate the use of a novel biomarker, presepsin, for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after PD. A prospective pilot study was conducted using 30 consecutive patients who underwent PD. Risk factors and candidates for predictive biomarkers for CR-POPF were statistically analyzed. CR-POPF (grade B and C; determined according to the guidelines of the International Study Group of Pancreatic Fistula) occurred in 15 patients (50%). Univariate analysis revealed that certain underlying conditions, including non-pancreatic cancer, smaller pancreatic ducts and soft pancreas texture were significantly associated with CR-POPF (P=0.005, P=0.004 and P=0.014, respectively). Furthermore, on day 1 post surgery (POD1), white blood cell count (P=0.040), levels of serum amylase (P=0.002) and serum presepsin (P=0.012), and the concentration of presepsin in drainage fluid (P<0.001) were significantly increased in CR-POPF compared with non-CR-POPF cases. Receiver operating characteristic curve analyses revealed that, on POD1, serum amylase and the concentration of presepsin in drainage fluid had an area under the curve value exceeding 0.8. A multivariate logistic regression analysis revealed that a higher concentration of presepsin in the drainage fluid was an independent predictive marker for CR-POPF (odds ratio, 14.503; 95% confidence interval, 1.750-120.229; P=0.013). To the best of our knowledge, the present study demonstrated for the first time that presepsin concentration in drainage fluid is a useful marker of CR-POPF after PD.
术后胰瘘（PF）是胰十二指肠切除术（PD）后发生的一种严重并发症。本研究的目的是评估一种新型生物标志物——可溶性髓系细胞触发受体-1（presepsin）在预测PD术后临床相关胰瘘（CR-POPF）中的应用。对连续30例行PD手术的患者进行了一项前瞻性初步研究。对CR-POPF的危险因素和预测生物标志物候选指标进行了统计学分析。15例患者（50%）发生了CR-POPF（B级和C级；根据国际胰瘘研究组的指南确定）。单因素分析显示，某些基础疾病，包括非胰腺癌、胰管较小和胰腺质地柔软，与CR-POPF显著相关（P分别为0.005、0.004和0.014）。此外，术后第1天（POD1），与非CR-POPF病例相比，CR-POPF患者的白细胞计数（P=0.040）、血清淀粉酶水平（P=0.002）、血清presepsin水平（P=0.012）以及引流液中presepsin浓度（P<0.001）显著升高。受试者工作特征曲线分析显示，在POD1时，血清淀粉酶和引流液中presepsin浓度的曲线下面积值超过0.8。多因素logistic回归分析显示，引流液中presepsin浓度较高是CR-POPF的独立预测指标（比值比，14.503；95%置信区间，1.750-120.229；P=0.013）。据我们所知，本研究首次证明引流液中presepsin浓度是PD术后CR-POPF 的有用标志物。
