The Systemic Inflammation-Based Prognostic Score Predicts Postoperative Complications in Patients Undergoing Pancreaticoduodenectomy

Figures & data

Table 1 Univariate Analysis of Risk Factors Associated with Postoperative Complications

Variables	All (n=172)	Postoperative Complications		P
		Yes (n=74)	No (n=98)
Age (years)	60.1±9.5	62.2±7.1	58.5±10.8	0.007
Gender (n,%)				0.002
Male	105 (61%)	55 (74%)	50 (51%)
Female	67 (39%)	19 (25.7%)	48 (49.0%)
BMI, kg/m2	23.87±3.00	4.16±2.77	3.65±3.15	0.271
Hypertension (n,%)	67 (39%)	29 (39.19%)	38 (38.78%)	0.956
Diabetes (n,%)	44 (25.6%)	22 (29.73%)	22 (22.45%)	0.279
ASA (n,%)				0.483
I	2 (1.2%)	0	2 (2.04%)
II	100 (58.1%)	41 (55.41%)	59 (60.20%)
III	69 (40.1%)	33 (44.59%)	36 (36.73%)
IV	1 (0.6%)	0	1 (1.02%)
Pre CRP, mg/L	13.39±5.81	19.02±33.98	8.75±15.07	0.033
Pre albumin, g/L	36.54± 4.29	35.59±4.40	37.26±4.08	0.011
Pre CAR	0.38±0.74	0.55±0.94	0.21±0.4	0.008
Pre mGPS≥1, n (%)	68 (39.53%)	40 (54.05%)	28 (28.57%)	<0.001
Surgical approach, n (%)				0.385
OPD	94 (54.7%)	36 (48.65%)	58 (59.18%)
LPD	59 (34.3%)	29 (39.19%)	30 (30.61%)
LPD convert to OPD	19 (11%)	9 (12.16%)	10 (10.20%)
Surgery time, min	262.50±108.57	313.24±114.80	281.58±102.11	0.058
Blood loss, mL	459.49±481.77	552.11±625.90	383.91±303.32	0.041
Blood transfusion, mL	165.58±304.93	191.08±329.58	146.33±285.13	0.342
Tumor character, n (%)				0.449
Malignant	136 (79.07%)	61 (82.43%)	75 (76.53%)
PDAC	19	15	4
Ampullary carcinoma	36	18	18
Distal bile duct carcinoma	45	23	22
Duodenal carcinoma	14	2	12
Other	22	3	19
Non-malignant	36 (20.93%)	13 (17.57%)	23 (23.47%)
CRP on POD3, mg/L	142.78±74.72	191.08±329.58	146.33±285.13	<0.001
Albumin on POD3, g/L	31.52±4.15	30.32±3.19	32.42±4.56	0.001
CAR on POD3	4.67±2.64	6.58±2.38	3.15±1.67	<0.001
poGPS≥1 on POD3, n (%)	76 (44.18)	57 (77.03%)	19 (19.39%)	<0.001
Postoperative stay (days)	18.00±18.33	31.69±23.42	8.43±10.16	<0.001
Reoperation, n	6	5	1	0.086
Mortality, n	2	1	1	1.0

Note: P<0.05 was significant.

Abbreviations: BMI, body mass index; Pre, preoperative; CRP, C-reactive protein; CAR, C-reactive protein/albumin ratio; mGPS, modified Glasgow Prognostic Score; OPD, open pancreaticoduodenectomy; LPD, laparoscopic pancreaticoduodenectomy; POD3, postoperative day 3; poGPS, postoperative Glasgow Prognostic Score.

Table 2 The Composition and Contents of Modified Glasgow Prognostic Score (mGPS) and Postoperative Glasgow Prognostic Score (poGPS)

Modified Glasgow Prognostic Score (mGPS)	mGPS
C-reactive protein < 10 mg/l and albumin >35 g/L	0
C-reactive protein ≥10 mg/L	1
C-reactive protein ≥ 10 mg/l and albumin <35 g/L	2
Postoperative Glasgow Prognostic Score (poGPS)	poGPS
C-reactive protein ≤150 mg/L albumin<25g/L or ≥ 25g/L	0
C-reactive protein >150 mg/L and albumin ≥25 g/L	1
C-reactive protein >150 mg/L and albumin <25 g/L	2

Table 3 Multivariate Analysis of Factors Associated with Postoperative Complications

Variables	OR	95% CI	P
Age, years	1.083	1.009–1.162	0.027
Gender (male)	0.188	0.051–0.694	0.012
Preoperative CRP, mg/L	1.027	0.998–1.057	0.072
Preoperative albumin, g/L	0.864	0.740–1.009	0.065
Blood loss, mL	1.001	0.999–1.002	0.324
CRP on POD3, mg/L	1.028	1.017–1.039	<0.001
Albumin on POD3, g/L	0.956	0.842–1.085	0.482

Abbreviations: OR, odds ratio; CI, confidence interval; CRP, C-reactive protein; POD3, postoperative day 3.

Table 4 Accuracy of Risk Factors in Predicting Postoperative Complications

Variable	AUC	P	Cut-off Value	Sensitivity	Specificity	NPV	PPV	Accuracy
Preoperative CAR	0.606	0.033	10.98	40.00%	83.56%	62.90%	66.70%	54.90%
Preoperative mGPS	0.667	<0.001						64.70%
			0	66.67%	63.01%	69.70%	59.70%
			1	25%	91.78%	59.80	71.40%
			2	0%	100%	54.90%	–
CRP on POD3	0.870	<0.001	142	82.43%	79.57%	85.10%	76.20%	77.80%
CAR on POD3	0.883	<0.001	4.86	79.73%	86.02%	84.20%	81.90%	82%
poGPS on POD3	0.780	<0.001						78.40%
			0	77.03%	79.57%	81.30%	75.00%
			1	5.41%	97.85%	56.50%	66.70%
			2	0%	100%	–	55.70%

Abbreviations: CAR, C-reactive protein/albumin ratio; CRP, C-reactive protein; mGPS, modified Glasgow Prognostic Score; poGPS, postoperative Glasgow Prognostic Score; POD3, postoperative day 3.

Figure 1 Receiver operating characteristic (ROC) curve of inflammation response-based indicators associated with postoperative complications.

Abbreviations: mGPS, modified Glasgow Prognostic Score; CAR, C-reactive protein/albumin; poGPS, postoperative Glasgow Prognostic Score; CRP, C-reactive protein; POD3, postoperative day 3.

Table 5 Incidence of Postoperative Complications Between Two Groups According to Postoperative C-Reactive Protein/Albumin Ratio (CAR)

Variables	CAR<4.86 (n=103)	CAR≥4.86 (n=69)	P
All	15 (14.6%)	59 (85.5%)	< 0.001
Grade I	3 (2.9%)	8 (11.6%)	< 0.001
Grade II	5 (4.9%)	28 (40.6%)	<0.001
Grade IIIa	3 (2.9%)	9 (13.0%)	< 0.001
Grade IIIb	2 (1.9%)	5 (7.2%)	0.001
Grade IVa	1 (1.0%)	6 (8.7%)	<0.001
Grade IVb	0	2 (1.9%)	–
Grade V	1 (1.0%)	1 (1.0%)	0.134
Grade III or great	7 (6.8%)	23 (33.3%)	<0.001
Pancreatic fistula (grade B/C)	5 (4.9%)	22 (33.3%)	0.001
Diameter	5 (3–6)	3 (3–4)	0.023
Pancreatic texture (soft texture,%)	9 (8.74%)	12 (17.39%)	0.095

Note: Clavien-Dindo complications grade.

Table 6 CAR of Two Groups in Predicting Intra-Abdominal Infection

Bacterials	CAR<4.86 (n=103)	CAR≥4.86 (n=69)	P
	11 (10.7%)	25 (36.2%)	<0.001
Enterococcus faecium	4	12
Candida albicans	2	2
Pseudomonas aeruginosa	2	2
Escherichia coli	1	6
Staphylococcus haemolyticus	1	3
Enterobacter cloacae	1	2
Aerogenes	1	0
Enterococcus faecalis	0	4
Klebsiella pneumoniae	0	2
Citrobacter freundii	0	2
Candida glabrata	0	1
Proteus mirabilis	0	1
Pseudomonas fluorescens	0	1
Stenotrophomonas maltophilia	0	1

Abbreviation: CAR, C-reactive protein/albumin ratio.

Figure 2 The receiver operating characteristic curve of CAR predicting abdominal infection on postoperative day 3 AUC=0.671, 95% CI=0.572–0.770, P=0.002.

Abbreviations: CAR, C-reactive protein/albumin; AUC, area under the curve; CI, confidence interval.

Figure 3 Receiver operating characteristic curve of CAR in predict of CR-POPF on postoperative day 3 AUC=0.732, 95% CI=0.633–0.830, P<0.001.

Abbreviations: CAR, C-reactive protein/albumin ratio; CR-POPF, clinical relevant postoperative pancreatic fistula; AUC, area under the curve; CI, confidence interval.