Limited utility of inflammatory markers in the early detection of postoperative inflammatory complications after pancreatic resection: Cohort study and meta-analyses

International Journal of Surgery
Leonardo SolainiHemant M Kocher

Abstract

To examine the diagnostic accuracy of systemic inflammatory markers in early prediction of inflammatory postoperative complications (IPC) and clinically-relevant pancreatic fistula (PF). Preoperative and postoperative [until postoperative day (POD) 4)] measurements of hemoglobin, white blood cell counts (WBC), neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) were correlated with IPC and PF. Meta-analyses of biochemical predictors were performed. Ninety-two out of 378 patients developed IPC, PF occurred in 31. Preoperative WBC (OR 1.0001, 95% CI: 1.0001-1.0002, p = 0.02), NLR on POD2 (OR 1.05, 95% CI: 1.006-1.1, p = 0.02) and CRP on POD4 (OR 1.006, 95% CI: 1.002-1.01, p = 0.02) predicted IPC at multivariate analysis. The model including these three variables showed a diagnostic accuracy of 76.8% (sensitivity 20, specificity 97%.14; PPV 71.43, PPN 77.27) and, at logistic regression analysis an OR of 8.5 (95% CI: 2.5-28.6, p < 0.001). Only CRP >272 on POD3 (OR 3.32, 95% CI: 1.46-7.52, p = 0.003) was associated with PF with a diagnostic accuracy of 74% (sensitivity 54.5, specificity 78.5; PPV 16.88, NPV 94.25). Meta-analyses of available data suggested sensitivity of 75.3% (95% CI 66.7-82.6) and specificity of 75.5% (...Continue Reading

References

Jan 29, 2003·JPEN. Journal of Parenteral and Enteral Nutrition·Kenneth A KudskBrock K King
Jul 9, 2005·Surgery·Claudio BassiUNKNOWN International Study Group on Pancreatic Fistula Definition
Aug 25, 2005·Journal of Surgical Oncology·S R WalshN J Keeling
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Mar 1, 2012·International Journal of Surgery·P G Vaughan-ShawA T King
Jan 15, 2014·Journal of Surgical Oncology·Kenichiro UemuraTaijiro Sueda

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Citations

Aug 19, 2020·Journal of Surgical Oncology·Yael NetanyahuEran Nizri
Jan 15, 2019·World Journal of Clinical Cases·Narongsak RungsakulkijSuraida Aeesoa
Jan 14, 2021·The Annals of Thoracic Surgery·Yaseen Al LawatiJonathan Cools-Lartigue

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