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C-Reactive Protein and Procalcitonin As Predictors of Postoperative Inflammatory Complications After Pancreatic Surgery
Giardino Alessandro*1, Gaya Spolverato1,2, Paolo Regi1, Isabella Frigerio1, Filippo Scopelliti1, Roberto Girelli1, Timothy M. Pawlik2, Paolo Pederzoli1, Giovanni Butturini1
1Surgery, Casa di Cura Pederzoli, Verona, Peschiera del Garda, Italy; 2Johns Hopkins Hospital, Baltimore, MD
Background: The association between postoperative inflammatory markers and risk of complications after pancreaticoduodenectomy (PD) is controversial. We sought to assess the diagnostic value of perioperative C-reactive protein (CRP) and procalcitonin (PCT) levels in the early identification of patients at risk for complications after pancreaticoduodenectomy (PD).
Method: In 2014, 84 patients undergoing elective PD were enrolled in a prospective database. Clinicopathological characteristics, CRP and PCT, as well as short-term outcomes, such as complications and pancreatic fistula, were analyzed. Complications and pancreatic fistula were defined based on the Clavien-Dindo classification and the International Study Group on Pancreatic Fistula (ISGPF) classification, respectively. High CRP and PCT were classified using cut-off values based on ROC curve analysis.
Results: The majority (73.8%) of patients had pancreatic adenocarcinoma. CRP and PCT levels over the first 5 post-operative days (POD) were higher among patients who experienced a complication versus those who did not (p<0.001). Postoperative CRP and PCT levels were also higher among patients who developed a grade B or C pancreatic fistula (p<0.05). A CRP concentration >84 mg/l on POD 1 (AUC 0.77) and >127 mg/l on POD 3 (AUC 0.79) was associated with the highest risk of overall complications (OR 6.86 and 9.0, respectively; both p<0.001). Similarly patients with PCT > 0.7 mg/dl on POD 1 (AUC 0.67) were at higher risk to develop a postoperative complication (OR 3.33; p=0.024). On POD 1 a CRP > 92 mg/l (AUC 0.72) and a PCT > 0.4 mg/dl (AUC 0.70) were associated with the highest risk of pancreatic fistula (OR 5.63 and 5.62 respectively; both p<0.05).
Conclusion: CRP and PCT concentration were associated with an increased risk to develop complications and clinical relevant pancreatic fistula after PD. Use of these biomarkers may help identify those patients at highest risk for perioperative morbidity and help guide postoperative management of patients undergoing PD.
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