The second-drop eosinophil ratio is useful for the early detection of severe complications after pancreaticoduodenectomy.

Abstract

Purpose: Pancreaticoduodenectomy is associated with high morbidity, notably due to complications, such as postoperative pancreatic fistula and intra-abdominal hemorrhaging. The early detection of such complications is crucial for improving outcomes. The peripheral blood eosinophil ratio, which reflects the endogenous corticosteroid activity, may indicate physiological stress or inflammation. This study evaluated whether or not changes in the eosinophil ratio could predict postoperative complications.

Methods: A retrospective review of patients who underwent pancreaticoduodenectomy between January 2011 and December 2020 at Jikei University Kashiwa Hospital was conducted. The postoperative eosinophil ratio trends were analyzed in relation to complications.

Results: Among 200 patients, 85 experienced Clavien-Dindo grade ≥ III complications. A biphasic pattern in the eosinophil ratio was observed in these patients, with a secondary decline correlating with the onset of complications. Using a cutoff of 0.95%, the sensitivity, specificity, and area under the curve for predicting severe complications were 0.92, 0.92, and 0.96, respectively (95% confidence interval 0.93-0.99).

Conclusion: A sustained decrease in the peripheral blood eosinophil ratio was associated with severe postoperative complications. This marker may be useful for early detection, enabling prompt diagnostic and therapeutic intervention following pancreaticoduodenectomy.