Predictive value of C-reactive protein/albumin ratio for complications after pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHENG Yifeng , HAN Xu , CHEN Qilong , CHENG Kun ,  LIN Hai

Department of Pancreatic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, P. R. China;

Corresponding author：

LIN Hai, Email: 13639966260@163.com

Keywords：

pancreaticoduodenectomy; postoperative complication; predictive value; C-reactive protein; albumin

DOI：

10.7507/1007-9424.201905110

Video：

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Objective To evaluate the predictive value of C-reactive protein/albumin ratio (CAR) for postoperative complications of pancreaticoduodenectomy (PD).Methods The clinical data of 134 patients with pancreaticoduodenectomy (PD) in the Department of Pancreatic Surgery of The First Affiliated Hospital of Xinjiang Medical University from 2015 to 2018 were retrospectively collected, including general conditions and postoperative complications. The predictive value of CAR was calculated.Results Of the 134 patients, 38 patients suffered from postoperative pancreatic fistula (POPF), 32 patients suffered from abdominal infection, 5 patients suffered from biliary fistula, 63 patients suffered from delayed gastric emptying (DGE), 13 patients suffered from post pancreatectomy hemorrhage (PPH), 8 patients suffered from wound infection, and 1 patient suffered from chyle leakage. There was no significant difference in general conditions such as gender, age, BMI, American Society of Anesthesiologists (ASA) score, tumor nature, tumor diameter, operative time, intraoperative blood loss, diabetes history, jaundice history, and drinking history (P>0.05), but the hospital stay in the complication group was longer than that of the non-complication group (P<0.05). The value of CAR in the pancreatic fistula and abdominal infection group were significantly higher than those in the non-complication group at 1 d, 3 d and 5 d (exclude 1 day after surgery on POPF), the difference was statistically significant (P<0.05). On the 3^rd day after surgery, the sensitivity of CAR predicting POPF was 79.95%, the specificity was 86.46%; the sensitivity of predicting abdominal infection was 75.00%, the specificity was 81.37%, and the result was better than using procalcitonin (PCT) alone, but similar with C-reactive protein (CRP) alone or CRP+PCT.Conclusion Postoperative CAR can better predict POPF and abdominal infection after PD, and the effect is better than PCT alone.

Citation： CHENG Yifeng, HAN Xu, CHEN Qilong, CHENG Kun, LIN Hai. Predictive value of C-reactive protein/albumin ratio for complications after pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(2): 137-142. doi: 10.7507/1007-9424.201905110 Copy

1.	Menahem B, Guittet L, Mulliri A, et al. Pancreaticogastrostomy is superior to pancreaticojejunostomy for prevention of pancreatic fistula after pancreaticoduodenectomy: an updated meta-analysis of randomized controlled trials. Ann Surg, 2015, 261(5): 882-887.
2.	李广洲, 朱宗文, 王水平, 等. 降钙素原对胰十二指肠切除术后腹腔感染早期的预测价值. 中华胰腺病杂志, 2018, 18(5): 313-317.
3.	Warschkow R, Beutner U, Steffen T, et al. Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1 832 patients. Ann Surg, 2012, 256(2): 245-250.
4.	吴国刚, 冷梅, 刘兆润, 等. C反应蛋白与降钙素原早期预测胰十二指肠切除术后胰瘘的临床价值. 中华肝胆外科杂志, 2017, 23(12): 827-831.
5.	Ge X, Cao Y, Wang H, et al. Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery. World J Surg Oncol, 2017, 15(1): 1-7.
6.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
7.	中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会, 中华外科杂志编辑部. 胰腺术后外科常见并发症诊治及预防的专家共识 (2017). 中华外科杂志, 2017, 55(5): 328-334.
8.	孔瑞, 胡继盛, 李乐, 等. 奥曲肽对胰十二指肠切除术后胰瘘影响的前瞻性研究. 中华外科杂志, 2016, 54(1): 21-24.
9.	Palani Velu LK, McKay CJ, Carter CR, et al. Serum amylase andC-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy. Br J Surg, 2016, 103(5): 553-563.
10.	Frask A, Orłowski M, Dowgiałło-Wnukiewicz N, et al. Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne, 2017, 12(2): 160-165.
11.	Tanaka H, Tamura T, Toyokawa T, et al. C-reactive protein elevation ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer: a retrospective study. BMC Surg, 2019, 19(1): 114.
12.	Gans SL, Atema JJ, van Dieren S, et al. Diagnostic value ofC-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis. Int J Colorectal Dis, 2015, 30(7): 861-873.
13.	Rodriguez-Lopez M, Tejero-Pintor FJ, Bailon-Cuadrado M, et al. Impaired immune reaction and increased lactate and C-reactive protein for early prediction of severe morbidity and pancreatic fistula after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int, 2019, [Epub ahead of print].
14.	Hübner M, Mantziari S, Demartines N, et al. Postoperative albumin drop is a marker for surgical stress and a predictor for clinical outcome: a pilot study. Gastroenterol Res Pract, 2016, 2016: 8743187.
15.	Hoeboer SH, Groeneveld AB, Engels N, et al. Rising C-reactive protein and procalcitonin levels precede early complications after esophagectomy. J Gastrointest Surg, 2015, 19(4): 613-624.
16.	Brocca A, Virzì GM, de Cal M, et al. Elevated levels of procalcitonin and interleukin-6 are linked with postoperative complications in cardiac surgery. Scand J Surg, 2017, 106(4): 318-324.
17.	Fairclough E, Cairns E, Hamilton J, et al. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med (Lond), 2009, 9(1): 30-33.
18.	Karayiannis D, Bouloubasi Z, Baschali A, et al. PostoperativeC-reactive protein to albumin ratio as a diagnostic tool for predicting complications after abdominal surgery. Clinical Nutrition ESPEN, 2018, 24: 176.
19.	Haruki K, Shiba H, Shirai Y, et al. The C-reactive protein to albumin ratio predicts long-term outcomes in patients with pancreatic cancer after pancreatic resection. World J Surg, 2016, 40(9): 2254-2260.
20.	徐杨, 丛壮壮, 冀赛光, 等. C-反应蛋白与清蛋白比值对微创食管癌术后并发症的早期预测价值. 东南国防医药, 2018, 20(4): 371-375.
21.	Solaini L, Atmaja BT, Watt J, et al. Limited utility of inflammatory markers in the early detection of postoperative inflammatory complications after pancreatic resection: cohort study and meta-analyses. Int J Surg, 2015, 17: 41-47.
22.	Welsch T, Frommhold K, Hinz U, et al. Persisting elevation ofC-reactive protein after pancreatic resections can indicate developing inflammatory complications. Surgery, 2008, 143(1): 20-28.
23.	Giardino A, Spolverato G, Regi P, et al. C-reactive protein and procalcitonin as predictors of postoperative inflammatory complications after pancreatic surgery. J Gastrointest Surg, 2016, 20(8): 1482-1492.
24.	Sasaki K, Asaoka T, Eguchi H, et al. Plasma ghrelin suppression as an early predictor for postoperative complications after pancreatoduodenectomy. Pancreatology, 2018, 18(1): 73-78.
25.	De Schryver N, Wittebole X, Hubert C, et al. Early hyperlactatemia predicts pancreatic fistula after surgery. BMC Anesthesiol, 2015, 15(1): 109.
26.	白思嘉, 沈力, 郑楷炼, 等. 降钙素原对胰十二指肠切除术后并发症的预测价值. 中华胰腺病杂志, 2017, 17(2): 104-108.

1. Menahem B, Guittet L, Mulliri A, et al. Pancreaticogastrostomy is superior to pancreaticojejunostomy for prevention of pancreatic fistula after pancreaticoduodenectomy: an updated meta-analysis of randomized controlled trials. Ann Surg, 2015, 261(5): 882-887.
2. 李广洲, 朱宗文, 王水平, 等. 降钙素原对胰十二指肠切除术后腹腔感染早期的预测价值. 中华胰腺病杂志, 2018, 18(5): 313-317.
3. Warschkow R, Beutner U, Steffen T, et al. Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1 832 patients. Ann Surg, 2012, 256(2): 245-250.
4. 吴国刚, 冷梅, 刘兆润, 等. C反应蛋白与降钙素原早期预测胰十二指肠切除术后胰瘘的临床价值. 中华肝胆外科杂志, 2017, 23(12): 827-831.
5. Ge X, Cao Y, Wang H, et al. Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery. World J Surg Oncol, 2017, 15(1): 1-7.
6. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
7. 中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺病专业委员会, 中华外科杂志编辑部. 胰腺术后外科常见并发症诊治及预防的专家共识 (2017). 中华外科杂志, 2017, 55(5): 328-334.
8. 孔瑞, 胡继盛, 李乐, 等. 奥曲肽对胰十二指肠切除术后胰瘘影响的前瞻性研究. 中华外科杂志, 2016, 54(1): 21-24.
9. Palani Velu LK, McKay CJ, Carter CR, et al. Serum amylase andC-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy. Br J Surg, 2016, 103(5): 553-563.
10. Frask A, Orłowski M, Dowgiałło-Wnukiewicz N, et al. Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne, 2017, 12(2): 160-165.
11. Tanaka H, Tamura T, Toyokawa T, et al. C-reactive protein elevation ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer: a retrospective study. BMC Surg, 2019, 19(1): 114.
12. Gans SL, Atema JJ, van Dieren S, et al. Diagnostic value ofC-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis. Int J Colorectal Dis, 2015, 30(7): 861-873.
13. Rodriguez-Lopez M, Tejero-Pintor FJ, Bailon-Cuadrado M, et al. Impaired immune reaction and increased lactate and C-reactive protein for early prediction of severe morbidity and pancreatic fistula after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int, 2019, [Epub ahead of print].
14. Hübner M, Mantziari S, Demartines N, et al. Postoperative albumin drop is a marker for surgical stress and a predictor for clinical outcome: a pilot study. Gastroenterol Res Pract, 2016, 2016: 8743187.
15. Hoeboer SH, Groeneveld AB, Engels N, et al. Rising C-reactive protein and procalcitonin levels precede early complications after esophagectomy. J Gastrointest Surg, 2015, 19(4): 613-624.
16. Brocca A, Virzì GM, de Cal M, et al. Elevated levels of procalcitonin and interleukin-6 are linked with postoperative complications in cardiac surgery. Scand J Surg, 2017, 106(4): 318-324.
17. Fairclough E, Cairns E, Hamilton J, et al. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med (Lond), 2009, 9(1): 30-33.
18. Karayiannis D, Bouloubasi Z, Baschali A, et al. PostoperativeC-reactive protein to albumin ratio as a diagnostic tool for predicting complications after abdominal surgery. Clinical Nutrition ESPEN, 2018, 24: 176.
19. Haruki K, Shiba H, Shirai Y, et al. The C-reactive protein to albumin ratio predicts long-term outcomes in patients with pancreatic cancer after pancreatic resection. World J Surg, 2016, 40(9): 2254-2260.
20. 徐杨, 丛壮壮, 冀赛光, 等. C-反应蛋白与清蛋白比值对微创食管癌术后并发症的早期预测价值. 东南国防医药, 2018, 20(4): 371-375.
21. Solaini L, Atmaja BT, Watt J, et al. Limited utility of inflammatory markers in the early detection of postoperative inflammatory complications after pancreatic resection: cohort study and meta-analyses. Int J Surg, 2015, 17: 41-47.
22. Welsch T, Frommhold K, Hinz U, et al. Persisting elevation ofC-reactive protein after pancreatic resections can indicate developing inflammatory complications. Surgery, 2008, 143(1): 20-28.
23. Giardino A, Spolverato G, Regi P, et al. C-reactive protein and procalcitonin as predictors of postoperative inflammatory complications after pancreatic surgery. J Gastrointest Surg, 2016, 20(8): 1482-1492.
24. Sasaki K, Asaoka T, Eguchi H, et al. Plasma ghrelin suppression as an early predictor for postoperative complications after pancreatoduodenectomy. Pancreatology, 2018, 18(1): 73-78.
25. De Schryver N, Wittebole X, Hubert C, et al. Early hyperlactatemia predicts pancreatic fistula after surgery. BMC Anesthesiol, 2015, 15(1): 109.
26. 白思嘉, 沈力, 郑楷炼, 等. 降钙素原对胰十二指肠切除术后并发症的预测价值. 中华胰腺病杂志, 2017, 17(2): 104-108.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Predictive value of C-reactive protein/albumin ratio for complications after pancreaticoduodenectomy

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