EVALUATION OF C-REACTIVE PROTEIN 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). The aim of this study was to assess the value of C-reactive protein (CRP) preoperatively and postoperatively as early predictor of POPF.
Method: 51 patients undergoing PD for various hepatobiliary and pancreatic diseases from November 2016 to November 2018 were included. Clinical, pathological, biochemical and intraoperative characteristics were recorded along with preoperative, post operative day 1 (POD1) and post operative day 3 (POD3) CRP values.Patients developing POPF were analyzed and were grouped into 2 categories - clinically relevant (Grade B+C) and clinically non relevant POPF (No POPF+Grade A/ Biochemical leak) according to the International Study Group on Pancreatic Surgery classification (2016). High CRP values were classified using cut off values based on ROC curve analysis.
Result: Out of the 51 patients, 13 developed clinically relevant POPF. POD1 and POD3 CRP values were found to be significantly correlated with clinically relevant POPF (p=0.025 and P=0.006, respectively). The development of clinically relevant POPFs could be predicted with 69.2% sensitivity and 60.5% specificity by POD1 CRP cut off value of 106.5 and with 76.9% sensitivity and 71.1% specificity by POD3 CRP cut off level of 199.5.
Conclusion: POD1 and POD3 CRP values can be used as early predictors of clinically relevant POPF after PD.
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