Early Postoperative Prediction of Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: usefulness of C-reactive Protein.

Abstract Background An early recognition of clinically relevant pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is essential. Methods All consecutive patients who underwent PD in two institutions were included (2013–2015). In all patients amylase value in drains (AVD) was evaluated in postoperative day 1 (POD1). White-blood cell count (WBC), serum pancreatic amylase (SPA) and C-reactive protein (CRP) were routinely evaluated in POD1, POD2, and POD3. Receiver operator characteristic (ROC) curves were performed. Significant diagnostic cut-offs were tested in a multivariate model. Results Overall, 463 patients underwent PD. Postoperative morbidity and mortality were 58% and 4%, respectively. Sixty-four patients (14%) had a clinically relevant PF (grade B or C). ROC curve analyses revealed that AVD on POD1 had the greatest area under the curve value (0.881, P P P  = 0.023), AVD on POD1>500 U/l (OR 21.72, 95%CI: 7.41–63.67, P  150 mg/l (OR 3.480, 95%CI: 1.21–9.99, P  = 0.021), and CRP on POD3 > 185 mg/l (OR 6.738, 95%CI: 1.91–23.78, P  = 0.003) as independent predictors of clinically relevant PF. Conclusion The combination of CRP and AVD was effective in the early prediction of clinically relevant POPF after PD.