Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria.
PLoS One. 2020 Dec 9;15(12):e0243510. doi: 10.1371/journal.pone.0243510. eCollection 2020.
Presepsin is involved in binding lipopolysaccharides and previous studies have confirmed its value as a marker for early diagnosis and prediction of severity in sepsis. Comparable studies assessing the predictive potential regarding postoperative complications and mortality following pancreatic resection are lacking.
This prospective study included 70 patients undergoing pancreatic resection from December 2017 until May 2019. Presepsin was measured preoperatively, on postoperative day 1, 3 and 8 (POD1/3/8) and correlated with the clinical course and mortality.
Severe complications (Clavien-Dindo ≥3a) occurred in 28 patients (40%), postoperative pancreatic fistula (POPF) grade B/C occurred in 20 patients (28.6%), infectious complications in 28 (40%), and four patients (5.7%) died during hospital stay. Presepsin levels at any timepoint did not correlate with further development of postoperative complications or in-hospital mortality whereas CRP levels on postoperative day (POD) 3 were significantly associated with clinically relevant POPF (AUC 0.664, 95%CI 0.528-0.800; p = 0.033). Preoperative Presepsin levels as well as Presepsin on POD1 were significantly elevated in patients with malignant compared to benign underlying disease (299pg/ml vs. 174pg/ml and 693.5pg/ml vs. 294pg/ml; p = 0.009 and 0.013, respectively).
In our cohort, Presepsin was not eligible to predict the postoperative course following pancreatic resection. However, Presepsin levels were significantly elevated in patients with malignant disease, this finding warrants further investigation.
Presepsin 参与结合脂多糖，先前的研究已经证实其作为脓毒症早期诊断和严重程度预测标志物的价值。缺乏评估胰腺切除术后术后并发症和死亡率预测潜力的可比研究。
这项前瞻性研究纳入了 2017 年 12 月至 2019 年 5 月期间接受胰腺切除术的 70 名患者。在术前、术后第 1、3 和 8 天（POD1/3/8）测量 presepsin，并与临床病程和死亡率相关。
28 名患者（40%）发生严重并发症（Clavien-Dindo ≥3a），20 名患者（28.6%）发生术后胰腺瘘（POPF）分级 B/C，28 名患者（40%）发生感染性并发症，4 名患者（5.7%）在住院期间死亡。presepsin 水平在任何时间点均与术后并发症的进一步发展或住院死亡率无关，而术后第 3 天（POD）的 CRP 水平与临床相关的 POPF 显著相关（AUC 0.664，95%CI 0.528-0.800；p=0.033）。与良性基础疾病相比，恶性基础疾病患者的术前 presepsin 水平和 POD1 时的 presepsin 水平显著升高（299pg/ml 比 174pg/ml 和 693.5pg/ml 比 294pg/ml；p=0.009 和 0.013）。
在我们的队列中，presepsin 没有资格预测胰腺切除术后的术后病程。然而，恶性疾病患者的 presepsin 水平显著升高，这一发现需要进一步研究。
