C-Reactive Protein and Procalcitonin as Predictors of Postoperative Inflammatory Complications After Pancreatic Surgery
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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 PD.
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.
The majority (73.8 %) of patients had pancreatic adenocarcinoma. CRP and PCT levels over the first 5 postoperative 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 of developing 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).
CRP and PCT concentration were associated with an increased risk of developing 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.
KeywordsC-reactive protein Procalcitonin Pancreatic surgery Complications Pancreatic fistula
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
- 1.Fu S, Shen S, Li S, Hu W, Hua Y, Kuang M, et al. Risk factors and outcomes of postoperative pancreatic fistula after pancreatico-duodenectomy: an audit of 532 consecutive cases. BMC Surgery, 2015. 15–34.Google Scholar
- 2.Paniccia A, Hosokawa P, Henderson W, Schulick RD, Edil BH, Mccarter MD, et al. Characteristics of 10-Year Survivors of Pancreatic Ductal Adenocarcinoma. JAMA Surg, 2015. 80045: p1–10.Google Scholar
- 4.Nagai S, Fujii T, Kodera Y, Kanda M, Sahin TT, Kanzaki a, et al. Recurrence pattern and prognosis of pancreatic cancer after pancreatic fistula. Ann Surg Oncol, 2011. 2329: p18–37.Google Scholar
- 7.Chen J, Feng J, Wang X, Cai S, Dong J, Chen Y, et al. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol, 2015. 21(19): p5926–33.Google Scholar
- 9.Welsch T, Müller SA, Ulrich A, Kischlat A. C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Surgery, 2007: p1499–507.Google Scholar
- 10.Facy O, Binquet C, Masson D, Fournel I, Rat P, Ortega-deballon P. Diagnostic Accuracy of Inflammatory Markers As Early Predictors of Infection After Elective Colorectal Surgery-Results From the IMACORS Study. Ann Surg, 2015. p1–6.Google Scholar
- 11.Lagoutte N, Facy O, Ravoire A, Chalumeau C, Jonval L, Rat P, et al. C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery : Pilot study in 100 patients. J. Visc. Surg, 2012. 149: p345–9Google Scholar
- 12.Warschkow R, Tarantino I, Schmied BM, Steffen T. Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after gastroesophageal cancer surgery. Langhenbecks Arch Surg, 2012. p727–36.Google Scholar
- 13.Oberhofer D. Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery. CMJ, 2012. p612–9.Google Scholar
- 14.Giaccaglia V, Salvi ÃPF, Antonelli ÃMS, Giacca M, Corcione F, Balducci G, et al. Procalcitonin Reveals Early Dehiscence in Colorectal Surgery The PREDICS Study. Ann Surg, 2015. 20(10): p1-6Google Scholar
- 15.Bianchi RA, Silva NA, Natal ML. Utility of base deficit , lactic acid , microalbuminuria , and C-reactive protein in the early detection of complications in the immediate postoperative evolution. Clin Biochem, 2004. 37: p404–7.Google Scholar
- 16.Siassi M, Riese J, Steffensen R, Meisner M, Thiel S, Hohenberger W, et al. Mannan-binding lectin and procalcitonin measurement for prediction of postoperative infection. Crit Care, 2005. 9: p 483–9Google Scholar
- 18.Meyer ZC, Schreinemakers JMJ, Waal RAL De. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit : a review. Surg. Today, 2015. p1091–101.Google Scholar
- 19.Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, et al. Procalcitonin , interleukin 6 and systemic inflammatory response syndrome ( SIRS ): early markers of postoperative sepsis after major surgery. B J Anaesth, 2005. 94: p767–73.Google Scholar
- 20.Silvestre J, Rebanda J, Lourenço C, Póvoa P. Diagnostic accuracy of C-reactive protein and procalcitonin in the early detection of infection after elective colorectal surgery – a pilot study. BMC Infectious Disease, 2014. 1–8.Google Scholar
- 22.Garcia-granero A, Frasson MDM, D BFP, Blanco F, Ph D, Puga R, et al. Procalcitonin and C-Reactive Protein as Early Predictors of Anastomotic Leak in Colorectal Surgery: A Prospective Observational Study. Dis Colon Rectum 2013. 56: p475–83.Google Scholar
- 31.Hoeboer SH, Groeneveld ABJ, Engels N, Genderen M Van. Rising C-Reactive Protein and Procalcitonin Levels Precede Early Complications After Esophagectomy. J Gastrointes Surg, 2015. 19: p613–24.Google Scholar