The diagnostic value of C-reactive protein for predicting pancreatic fistula following pancreatoduodenectomy

Abstract

Introduction

Pancreaticoduodenectomy is the preferred treatment of neoplasms in the pancreas and duodenum. Postoperative pancreatic fistula is a critical complication. A potential predictive marker is C-reactive protein. This retrospective study examined the predictive value of C-reactive protein as a marker for development of postoperative pancreatic fistulas.

Methods

All patients who had a pancreaticoduodenectomy from 1 January 2015 to 31 December 2019, were included. Levels of the biomarker and linear trajectory were determined for postoperative days one to four. Univariate analysis was used to identify predictive variables for a postoperative pancreatic fistula. Receiver operating characteristics curves, specificity, and sensitivity were calculated.

Results

Five hundred and fifty-two patients underwent pancreaticoduodenectomy. C-reactive protein level greater than 121.5mg/L on the third postoperative day and an increase in C-reactive protein level between the first and fourth postoperative days, greater than 21.7mg/L, seemed to be reliable predictors. For Grade C postoperative pancreatic fistulas, increases in C-reactive protein, greater than 40.6ml/L the first four postoperative days, had a sensitivity of 100%. White blood cell count did not have similar reliability in predicting postoperative pancreatic fistulas.

Conclusion

Our findings indicate that small rises in C-reactive protein during the first postoperative days after pancreaticoduodenectomy are associated with an increased risk of developing postoperative pancreatic fistula.

Keywords:

• Pancreatoduodenectomy
• c-reactive protein
• pancreas
• pancreatic fistula
• postoperative complication

Author contributions

WF: designed study, wrote the paper, analyzed data, approved the final version; KAR: designed study, analyzed data, revised paper, approved the final version; LP: designed study, analyzed data, revised paper, approved the final version; CDV: designed study, analyzed data, revised paper, approved the final version; JHS: designed study, revised paper, approved the final version; CPH: designed study, revised paper, approved the final version.

Disclosure statement

The authors have no conflicts of interest.