An Invited Commentary on “C-reactive protein and drain amylase accurately predict clinically relevant pancreatic fistula after partial pancreaticoduodenectomy”

2020 ◽  
Vol 77 ◽  
pp. 112-113
Author(s):  
Maria Michela Chiarello ◽  
Giuseppe Brisinda
Keyword(s):  
Pancreatic Fistula ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Partial Pancreaticoduodenectomy ◽  
Drain Amylase

Postoperative Pancreatic Swelling Predicts Pancreatic Fistula after Pancreaticoduodenectomy

2019 ◽  
Vol 85 (4) ◽  
pp. 321-326 ◽  
Author(s):  
Hiroya Iida ◽  
Masaji Tani ◽  
Hiromitsu Maehira ◽  
Haruki Mori ◽  
Naomi Kitamura ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Protein Level ◽  
Operation Time ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Before And After ◽  
Pancreatic Thickness ◽  
Drain Amylase

Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy. However, the criteria for prompting drainage have not been clarified yet. We evaluated 80 patients who underwent pancreaticoduodenectomy between 2011 and 2016. Clinically relevant POPF (International Study Group of Postoperative Pancreatic Fistula grade B or C) was evaluated on the basis of the following parameters: changes in pancreatic thickness between preoperation and postoperative day (POD) 4 identified via enhanced CT, drain amylase level, laboratory data, and operative factors. POPF occurred in 21 patients (26.3%). The median change in pancreatic thickness before and after operation was 8.33 mm in the POPF-positive group, which was significantly larger than that in the POPF-negative group (3.79 mm, P <0.001). In addition, operation time, pancreatic texture, main pancreatic duct diameter, WBC count, C-reactive protein level, and drain amylase level demonstrated significant differences between the groups. In the multivariate analysis, operation time, C-reactive protein level on POD 3, drain amylase level on POD 1, and the change in pancreatic thickness before and after operation were independent risk factors of POPF. The drastic change in pancreatic thickness before and after operation predicted POPF in this study. This might be one of the factors that determine the requirement for drainage.

scholarly journals Predictive Significance of C-reactive Protein-to-albumin Ratio for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

2019 ◽  
Vol 39 (11) ◽  
pp. 6283-6290 ◽  
Author(s):  
TERUHISA SAKAMOTO ◽  
YAKUKI YAGYU ◽  
EI UCHINAKA ◽  
MASAKI MORIMOTO ◽  
TAKEHIKO HANAKI ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein

scholarly journals Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Runwen Liu ◽  
Yunqiang Cai ◽  
He Cai ◽  
Yajia Lan ◽  
Lingwei Meng ◽  
...  
Keyword(s):  
Prediction Model ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
C Reactive Protein ◽  
Dynamic Prediction ◽  
Albumin Ratio ◽  
Drainage Fluid ◽  
Reactive Protein ◽  
Baseline Factors

Abstract Background With the recent emerge of dynamic prediction model on the use of diabetes, cardiovascular diseases and renal failure, and its advantage of providing timely predicted results according to the fluctuation of the condition of the patients, we aim to develop a dynamic prediction model with its corresponding risk assessment chart for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy by combining baseline factors and postoperative time-relevant drainage fluid amylase level and C-reactive protein-to-albumin ratio. Methods We collected data of 251 patients undergoing LPD at West China Hospital of Sichuan University from January 2016 to April 2019. We extracted preoperative and intraoperative baseline factors and time-window of postoperative drainage fluid amylase and C-reactive protein-to-albumin ratio relevant to clinically relevant pancreatic fistula by performing univariate and multivariate analyses, developing a time-relevant logistic model with the evaluation of its discrimination ability. We also established a risk assessment chart in each time-point. Results The proportion of the patients who developed clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy was 7.6% (19/251); preoperative albumin and creatine levels, as well as drainage fluid amylase and C-reactive protein-to-albumin ratio on postoperative days 2, 3, and 5, were the independent risk factors for clinically relevant postoperative pancreatic fistula. The cut-off points of the prediction value of each time-relevant logistic model were 14.0% (sensitivity: 81.9%, specificity: 86.5%), 8.3% (sensitivity: 85.7%, specificity: 79.1%), and 7.4% (sensitivity: 76.9%, specificity: 85.9%) on postoperative days 2, 3, and 5, respectively, the area under the receiver operating characteristic curve was 0.866 (95% CI 0.737–0.996), 0.896 (95% CI 0.814–0.978), and 0.888 (95% CI 0.806–0.971), respectively. Conclusions The dynamic prediction model for clinically relevant postoperative pancreatic fistula has a good to very good discriminative ability and predictive accuracy. Patients whose predictive values were above 14.0%, 8.3%, and 7.5% on postoperative days 2, 3, and 5 would be very likely to develop clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy.

783 C-REACTIVE PROTEIN VERSUS DRAIN AMYLASE; THEIR RELIABILITY IN RULING OUT ANASTOMOTIC LEAKAGE AFTER MINIMALLY INVASIVE IVOR-LEWIS ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
S Stuart ◽  
T Kuypers ◽  
I Martijnse ◽  
J Heisterkamp ◽  
R Matthijsen
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
High Sensitivity ◽  
Roc Curves ◽  
Therapeutic Interventions ◽  
C Reactive Protein ◽  
Timely Initiation ◽  
Ivor Lewis ◽  
Reactive Protein ◽  
Drain Amylase

Abstract   One of the most feared complications of the esophagectomy for esophageal cancer is anastomotic leakage (AL). Early diagnosis is vital for timely initiation of therapeutic interventions as well as prompting early feeding in the absence of AL. The aim of this study is to investigate the role of serum C-reactive protein (CRP) and drain amylase levels in the early detection of AL. Methods All 109 patients who underwent a minimally invasive Ivor-Lewis procedure in our hospital between January 2018 and October 2020 were retrospectively included in this study. Data on CRP and drain amylase levels were collected during the first 5 postoperative days (POD) and were available for analyses. Mean CRP and median drain amylase levels between patients with and without AL were compared and ROC curves on POD 3, 4 and 5 were plotted to calculate cut-off values for CRP. Results In 13 of 109 patients (12%) AL was diagnosed with a median time to diagnosis of 8 days. Mean CRP was significantly higher in patients with AL on POD 3, 4 and 5. Cut-off values of 48, 113 and 90 mg/L had a high sensitivity of 100%, 92% and 92% on POD 3, 4 and 5. No difference in median drain amylase levels was observed. Conclusion CRP levels with a cut-off point of 113 mg/L on POD 4 do not improve earlier detection of AL, but has a high sensitivity for excluding AL while the value of drain amylase in the first 5 days after surgery is limited.

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