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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.	李廣洲, 朱宗文, 王水平, 等. 降鈣素原對胰十二指腸切除術后腹腔感染早期的預測價值. 中華胰腺病雜志, 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.	吳國剛, 冷梅, 劉兆潤, 等. C反應蛋白與降鈣素原早期預測胰十二指腸切除術后胰瘺的臨床價值. 中華肝膽外科雜志, 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.	中華醫學會外科學分會胰腺外科學組, 中國研究型醫院學會胰腺病專業委員會, 中華外科雜志編輯部. 胰腺術后外科常見并發癥診治及預防的專家共識 (2017). 中華外科雜志, 2017, 55(5): 328-334.
8.	孔瑞, 胡繼盛, 李樂, 等. 奧曲肽對胰十二指腸切除術后胰瘺影響的前瞻性研究. 中華外科雜志, 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, Or?owski M, Dowgia??o-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.	徐楊, 叢壯壯, 冀賽光, 等. C-反應蛋白與清蛋白比值對微創食管癌術后并發癥的早期預測價值. 東南國防醫藥, 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, 鄭楷煉, 等. 降鈣素原對胰十二指腸切除術后并發癥的預測價值. 中華胰腺病雜志, 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. 李廣洲, 朱宗文, 王水平, 等. 降鈣素原對胰十二指腸切除術后腹腔感染早期的預測價值. 中華胰腺病雜志, 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. 吳國剛, 冷梅, 劉兆潤, 等. C反應蛋白與降鈣素原早期預測胰十二指腸切除術后胰瘺的臨床價值. 中華肝膽外科雜志, 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. 中華醫學會外科學分會胰腺外科學組, 中國研究型醫院學會胰腺病專業委員會, 中華外科雜志編輯部. 胰腺術后外科常見并發癥診治及預防的專家共識 (2017). 中華外科雜志, 2017, 55(5): 328-334.
8. 孔瑞, 胡繼盛, 李樂, 等. 奧曲肽對胰十二指腸切除術后胰瘺影響的前瞻性研究. 中華外科雜志, 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, Or?owski M, Dowgia??o-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. 徐楊, 叢壯壯, 冀賽光, 等. C-反應蛋白與清蛋白比值對微創食管癌術后并發癥的早期預測價值. 東南國防醫藥, 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, 鄭楷煉, 等. 降鈣素原對胰十二指腸切除術后并發癥的預測價值. 中華胰腺病雜志, 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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content