Back to Search
Start Over
Postoperative day 1 combination of serum C-reactive protein and drain amylase values predicts risks of clinically relevant pancreatic fistula. The '90-1000' score
- Source :
- Surgery. 170:1508-1516
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Several scoring systems predict risks of clinically relevant postoperative pancreatic fistula after pancreatectomy, but none have emerged as the gold standard. This study aimed to evaluate the accuracy of postoperative day 1 drain amylase and serum C-reactive protein levels in predicting clinically relevant postoperative pancreatic fistula compared with intraoperative pancreatic characteristics.Patients who underwent pancreatectomy between 2017 and 2019 were included prospectively. Cutoff values were determined using receiver operating characteristic curves, and a score combining postoperative day 1 drain amylase and serum C-reactive protein was tested in a multivariate logistic regression model to evaluate clinically relevant postoperative pancreatic fistula risk.A total of 274 pancreatic resections (182 pancreaticoduodenectomies and 92 distal pancreatectomies) were included. The pancreatic gland texture was "soft" in 47.8% (n = 131), and 55.8% (n = 153) had a small size main pancreatic duct (≤3 mm). Clinically relevant postoperative pancreatic fistula occurred in 58 patients (21.2%). Drain amylase ≥1,000 UI/L and serum C-reactive protein ≥90 mg/L were identified as the optimal cutoffs to predict clinically relevant postoperative pancreatic fistula. On multivariate analysis these cutoffs were independent predictors of clinically relevant postoperative pancreatic fistula after both pancreaticoduodenectomies (drain amylase: P.001, serum C-reactive protein: P = .006) and distal pancreatectomies (drain amylase: P = .009, serum C-reactive protein: P = .001). The postoperative day 1 "90-1000" model, a 2-value score relying on these cutoffs, significantly (P.001) outperformed intraoperative pancreatic parenchymal characteristics in predicting clinically relevant postoperative pancreatic fistula after both pancreaticoduodenectomies and distal pancreatectomies. A postoperative day 1 "90-1000" score = 0 had a negative predictive value of 97% and 94%, respectively, after pancreaticoduodenectomy and distal pancreatectomies.A combined score relying on postoperative day 1 values of drain amylase and serum C-reactive protein levels was accurate in predicting risks of clinically relevant postoperative pancreatic fistula after pancreatectomy.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
030230 surgery
Gastroenterology
Pancreatic Fistula
03 medical and health sciences
Pancreatectomy
0302 clinical medicine
Internal medicine
Humans
Medicine
Prospective Studies
Amylase
Pancreas
Aged
Pancreatic duct
biology
Receiver operating characteristic
business.industry
C-reactive protein
Gold standard (test)
Middle Aged
medicine.disease
Multivariate logistic regression model
C-Reactive Protein
medicine.anatomical_structure
Pancreatic fistula
030220 oncology & carcinogenesis
Amylases
biology.protein
Female
Surgery
France
business
Subjects
Details
- ISSN :
- 00396060
- Volume :
- 170
- Database :
- OpenAIRE
- Journal :
- Surgery
- Accession number :
- edsair.doi.dedup.....dc94a8e2db9d76a69a1c123ea1eb09d2