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Factors predicting 30-day mortality after pancreaticoduodenectomy—the impact of elevated aspartate aminotransferase

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Abstract

Purpose

High preoperative bilirubin levels and cholangitis are associated with poor peri-operative outcomes following pancreaticoduodenectomy (PD). However, the impact of deranged preoperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on immediate postoperative outcomes is relatively unexplored. We hypothesized that deranged AST and ALT lead to worse postoperative outcomes after PD. The aim of this study was to assess the factors contributing to postoperative mortality (POM) following PD, and to study the impact of deranged aminotransferases.

Methods

This is a retrospective analysis of 562 patients. Risk factors for POM were computed using a multivariate logistic regression model.

Results

The rate of POM was 3.9%. On univariate analysis, the American Society of Anaesthesiologists grades, diabetes mellitus, cardiac comorbidity, preoperative biliary stenting, elevated serum bilirubin, AST, elevated serum creatinine, clinically relevant pancreatic fistula (CRPF), and grade B+C post-pancreatectomy hemorrhage (PPH) were associated with 30-day mortality. On multivariate analysis, preoperative elevated AST was independently predictive of 30-day POM (OR = 6.141, 95%CI 2.060–18.305, p = 0.001). Other factors independently predictive of POM were elevated serum creatinine, preoperative biliary stenting, CRPF and grade B and C PPH. The ratio of AST/ALT > 0.89 was associated with 8 times increased odds of POM.

Conclusion

Elevated preoperative AST emerged as a predictor of 30-day POM after PD, with an 8-times increased odds of death with an AST/ALT ratio > 0.89.

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Data Availability

Data in the manuscript is available.

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Authors and Affiliations

  1. Division of GI Surgery, GI Oncology, Minimal Access and Bariatric Surgery, Institute of Digestive and Hepatobiliary Sciences, Medanta - the Medicity, Sector 38, Gurugram, Haryana, 122001, India

    Deeksha Kapoor, Azhar Perwaiz, Amanjeet Singh & Adarsh Chaudhary

  2. Department of Data Science, Alke Research Private Limited, Bengaluru, Karnataka, India

    Arun N. Kumar

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  1. Deeksha Kapoor
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  2. Azhar Perwaiz
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  5. Adarsh Chaudhary
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Contributions

Study design and conception—Deeksha Kapoor, Adarsh Chaudhary, Azhar Perwaiz, Arun Kumar N. Data acquisition—Deeksha Kapoor. Data analysis and interpretation—Deeksha Kapoor, Amanjeet Singh, Adarsh Chaudhary, Arun Kumar N. Drafting the article—Deeksha Kapoor, Azhar Perwaiz, Adarsh Chaudhary, Amanjeet Singh, Arun Kumar N. Critical review of intellectual content—Deeksha Kapoor, Azhar Perwaiz, Amanjeet Singh, Adarsh Chaudhary, Arun Kumar N.

Corresponding author

Correspondence to Adarsh Chaudhary.

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Ethics approval

We the authors, Deeksha Kapoor, Azhar Perwaiz, Amanjeet Singh, Arun Kumar N and Adarsh Chaudhary, have obeyed and complied with ethical standards. The study was reviewed by the Institutional Review Board and ethics committee approval was obtained (1247/2021). A part of the results was presented at the AHPBA 2021, on-demand presentation.

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Kapoor, D., Perwaiz, A., Singh, A. et al. Factors predicting 30-day mortality after pancreaticoduodenectomy—the impact of elevated aspartate aminotransferase. Langenbecks Arch Surg 408, 130 (2023). https://doi.org/10.1007/s00423-023-02865-w

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