Early prediction of post-pancreatectomy acute pancreatitis after pancreaticoduodenectomy based on serum C-reactive protein.

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2025-01-11 DOI:10.1016/j.pan.2025.01.002

Haoda Chen, Chao Wang, Wentao Xia, Ningzhen Fu, Yiran Zhou, Rui Ding, Weishen Wang, Zhiwei Xu, Xiaxing Deng, Yuanchi Weng, Baiyong Shen

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引用次数: 0

Abstract

Background: Post-pancreatectomy acute pancreatitis (PPAP) is an early acute inflammatory process of the pancreatic remnant that is associated with a series of downstream pancreas-specific complications. This study aimed to investigate the relationship between postoperative serum C-reactive protein (CRP) levels and the occurrence of PPAP after pancreaticoduodenectomy (PD).

Methods: Consecutive patients who underwent PD between January 1, 2020, and May 31, 2022, were retrospectively analyzed. PPAP was defined according to the International Study Group for Pancreatic Surgery (ISGPS) definitions. A Sankey diagram incorporating Fistula Risk Score (FRS), serum amylase levels, and serum CRP levels was further performed for the early iterative risk stratification of PPAP.

Results: A total of 601 patients were included in the analysis. Postoperative serum hyperamylasemia (POH) was observed in 268 patients (44.6 %), of whom 136 (16.7 %) developed PPAP after PD. Patients with serum CRP >100 mg/L on postoperative day (POD) 2 had a significantly higher incidence of PPAP (27.2 % vs. 2.3 %, p < 0.001). The highest Youden index was achieved with the cut-off value of 100 mg/L, with the area under the curve (AUC) value of 0.754 for predicting PPAP (sensitivity 91.8 %, specificity 59.0 %). Multivariate analysis revealed that body mass index (BMI) ≥24 (OR 2.09), estimated blood loss >200 mL (OR 1.70), and elevated serum CRP levels (OR 13.01) were independent risk factors for PPAP. Notably, patients with both POH and elevated serum CRP levels on POD 2 were classified as the high-risk group, exhibiting a remarkably high PPAP rate of 41.8 %.

Conclusions: Serum CRP levels on POD 2 are strongly associated with the development of PPAP after PD. This finding has the potential to enable tailored postoperative management and pave the way for the anti-inflammation strategies targeting the early postoperative period.

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基于血清c反应蛋白的胰十二指肠切除术后急性胰腺炎早期预测。

背景：胰腺切除术后急性胰腺炎（PPAP）是胰腺残余的早期急性炎症过程，与一系列下游胰腺特异性并发症相关。本研究旨在探讨胰十二指肠切除术（PD）术后血清c反应蛋白（CRP）水平与PPAP发生的关系。方法：回顾性分析2020年1月1日至2022年5月31日期间连续接受PD治疗的患者。PPAP是根据国际胰腺外科研究小组（ISGPS）的定义定义的。结合瘘风险评分（FRS）、血清淀粉酶水平和血清CRP水平的Sankey图进一步用于PPAP的早期迭代风险分层。结果：共纳入601例患者。术后血清高淀粉酶血症（POH） 268例（44.6%），其中136例（16.7%）发生PPAP。术后1天（POD） 2血清CRP水平为100 mg/L的患者PPAP发生率明显高于对照组（27.2% vs. 2.3%, p 200 mL (OR 1.70)），血清CRP水平升高（OR 13.01）是PPAP发生的独立危险因素。值得注意的是，POH和POD 2血清CRP水平升高的患者被归为高危组，PPAP率高达41.8%。结论：血清CRP水平与PD后PPAP的发生密切相关。这一发现有可能实现量身定制的术后管理，并为针对术后早期的抗炎策略铺平道路。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.