EVALUATION OF PROCALCITONIN AS A PREDICTOR OF POST-OPERATIVE PANCREATIC FISTULA AFTER PANCREATICODUODENECTOMY ( AN OBSERVATIONAL STUDY)
Palak Rath*1, Vikas Gupta1, Thakur D. Yadav1, Rakesh Kochhar2, Saroj Sinha2, Harjeet Singh1, Dr. Sanjay Bhadada3, Naresh Sachdeva3
1General Surgery, PGIMER, Chandigarh, Chandigarh, India; 2Gastroenterology, PGIMER, Chandigarh, India, India; 3Endocrinology, PGIMER, Chandigarh, India, India
Introduction: Postoperative pancreatic fistula (POPF) is a major complication after Pancreaticoduodenectomy (PD). In this study, we assess the values of preoperative and postoperative procalcitonin as early predictors of POPF.
Method:98 patients undergoing PD for various hepatobiliary and pancreatic diseases from November 2016 to November 2018 were included. Clinical, pathological, biochemical and intraoperative data were recorded along with preoperative, postoperative day 1 (POD1), postoperative day 3 (POD3) procalcitonin values and were analyzed. Patients were randomly divided into 2 groups- Training cohort (n=50) and Validation cohort (n=48). In each, they were classified into clinically relevant (Grade B+C) and clinically non relevant POPF ( No POPF + Grade A) according to the International Study Group on Pancreatic Surgery 2016 classification. High POD3 procalcitonin values in the training cohort were classified using cut off values based on ROC curve analysis and was applied to the validation cohort to re-define POPF.
Result: In the Training cohort, 12 patients developed clinically relevant POPF. Both the groups- with and without POPF were comparable in terms of demographic data, presence of jaundice and comorbidities. The incidence of clinically relevant POPF was higher amongst the patients having POD3 procalcitonin value more than 1.18 ( AUC=0.71, sensitivity=66%, Specificity=76%, p=0.028). In the Validation cohort, 16 developed clinically relevant POPF. When re-defined according to the new cut off value of POD3 procalcitonin 1.18 ( from training cohort), 20 were predicted to have clinically relevant POPF ( New test: sensitivity= 50%, specificity=62.5%, PPV=40%, NPV=71.4%)
Conclusion: Patients having POD3 procalcitonin value less than 1.18 have a high probability of NOT developing POPF. Hence, procalcitonin can be used as an early predictor of POPF.
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