Postoperative Procalcitonin is a Biomarker for Excluding the Onset of Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy

Overview

Journal J Gastrointest Oncol

Date 2023 May 18

PMID 37201045

Authors

Alessandro Coppola

Vincenzo La Vaccara

Silvia Angeletti

Silvia Spoto

Tommaso Farolfi

Roberto Cammarata

Girolamo Maltese

Roberto Coppola

Damiano Caputo

Affiliations

Soon will be listed here.

Abstract

Background: Early detection and therapy of pancreatic fistula after pancreaticoduodenectomy is crucial to improve outcomes of this surgery. Since it is not clear if procalcitonin (PCT), can predict the onset of clinically relevant post-operative pancreatic fistula (CR-POPF), we aimed to investigate this ability.

Methods: One-hundred-thirty pancreaticoduodenectomies (PD) were analyzed. Receiver Operating Characteristic curves analysis defined the optimal cut-offs for PCT and drains amylase levels (DAL). Complications were compared using chi-square for proportions test.

Results: DAL ≥2,000 U/L in postoperative day (POD) 2 had 71% positive predictive value (PPV) and 91% negative predictive value (NPV) for CR-POPF (P<0.001). In POD2, PCT ≥0.5 ng/mL showed NPV 91% (P<0.045) and increased DAL PPV for CR-POPF to 81%. In POD3, POD4 and POD5, DAL (cut-offs 780, 157 and 330 U/L, respectively) showed NPV for CR-POPF >90% (P<0.0001). PCT ≥0.5 ng/mL showed NPV for CR-POPF of about 90%. In POD5, combining DAL (cut-off 330 U/L) and PCT (cut-off 0.5 ng/mL), a PPV for CR-POPF of 81% was detected. A progressive increased risk of CR-POPF from POD2 [odds ratio (OR) =3.05; P=0.0348] to POD5 (OR =4.589; P=0.0082) was observed. In POD2 and 5, PCT ≥0.5 ng/mL, alone and in combination with DAL, may be a reliable marker for identifying patients at highest risk of CR-POPF after PD.

Conclusions: This association could be proposed to select high risk patients that could benefit of "intensive" postoperative management.

Citing Articles

Predictive value of C-reactive protein, procalcitonin, and total bilirubin levels for pancreatic fistula after gastrectomy for gastric cancer.

Yuan J, Wen X, Xiong P, Pei L World J Gastrointest Surg. 2025; 17(2):103266.

PMID: 40061988 PMC: 11886006. DOI: 10.4240/wjgs.v17.i2.103266.

Development and validation of a nomogram based on preoperative factors for predicting clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy.

Sheng J, Yang Y, Tang N, Lu C, Mao L, Qiu Y Gland Surg. 2025; 14(1):37-47.

PMID: 39958901 PMC: 11826256. DOI: 10.21037/gs-24-249.

References

Hata T, Mizuma M, Motoi F, Hayashi H, Ishida M, Ohtsuka H . Serum procalcitonin as an early diagnostic marker of severe postoperative complications after elective pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2020; 27(10):767-775. DOI: 10.1002/jhbp.809. View

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M . 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. DOI: 10.1016/j.surg.2016.11.014. View

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J . Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138(1):8-13. DOI: 10.1016/j.surg.2005.05.001. View

Pedrazzoli S, Liessi G, Pasquali C, Ragazzi R, Berselli M, Sperti C . Postoperative pancreatic fistulas: preventing severe complications and reducing reoperation and mortality rate. Ann Surg. 2008; 249(1):97-104. DOI: 10.1097/SLA.0b013e31819274fe. View

Kanda M, Fujii T, Takami H, Suenaga M, Inokawa Y, Yamada S . Novel diagnostics for aggravating pancreatic fistulas at the acute phase after pancreatectomy. World J Gastroenterol. 2014; 20(26):8535-44. PMC: 4093703. DOI: 10.3748/wjg.v20.i26.8535. View

Vollmer Jr C, Sanchez N, Gondek S, McAuliffe J, Kent T, Christein J . A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg. 2011; 16(1):89-102. DOI: 10.1007/s11605-011-1753-x. View

Arkader R, Troster E, Lopes M, Junior R, Carcillo J, Leone C . Procalcitonin does discriminate between sepsis and systemic inflammatory response syndrome. Arch Dis Child. 2005; 91(2):117-20. PMC: 2082702. DOI: 10.1136/adc.2005.077446. View

Chiba N, Ochiai S, Yokozuka K, Gunji T, Sano T, Tomita K . Risk Factors for Life-threatening Grade C Postoperative Pancreatic Fistula After Pancreatoduodenectomy Compared to Grade B. Anticancer Res. 2019; 39(4):2199-2205. DOI: 10.21873/anticanres.13335. View

Chen J, Feng J, Wang X, Cai S, Dong J, Chen Y . Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol. 2015; 21(19):5926-33. PMC: 4438027. DOI: 10.3748/wjg.v21.i19.5926. View

10.

Israel J, Rettammel R, Leverson G, Hanks L, Cho C, Winslow E . Does postoperative drain amylase predict pancreatic fistula after pancreatectomy?. J Am Coll Surg. 2014; 218(5):978-87. DOI: 10.1016/j.jamcollsurg.2014.01.048. View

11.

Yang J, Huang Q, Wang C . Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis. Int J Surg. 2015; 22:38-45. DOI: 10.1016/j.ijsu.2015.07.007. View

12.

Mintziras I, Maurer E, Kanngiesser V, Bartsch D . C-reactive protein and drain amylase accurately predict clinically relevant pancreatic fistula after partial pancreaticoduodenectomy. Int J Surg. 2020; 76:53-58. DOI: 10.1016/j.ijsu.2020.02.025. View

13.

Bardol T, Delicque J, Hermida M, Herrero A, Guiu B, Fabre J . Neck transection level and postoperative pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study of 195 patients. Int J Surg. 2020; 82:43-50. DOI: 10.1016/j.ijsu.2020.08.001. View

14.

Coppola A, La Vaccara V, Farolfi T, Fiore M, Cascone C, Ramella S . Different Biliary Microbial Flora Influence Type of Complications after Pancreaticoduodenectomy: A Single Center Retrospective Analysis. J Clin Med. 2021; 10(10). PMC: 8157867. DOI: 10.3390/jcm10102180. View

15.

Molinari E, Bassi C, Salvia R, Butturini G, Crippa S, Talamini G . Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg. 2007; 246(2):281-7. PMC: 1933557. DOI: 10.1097/SLA.0b013e3180caa42f. View

16.

Ma J, Jiang P, Ji B, Song Y, Liu Y . Post-operative procalcitonin and C-reactive protein predict pancreatic fistula after laparoscopic pancreatoduodenectomy. BMC Surg. 2021; 21(1):171. PMC: 8008693. DOI: 10.1186/s12893-021-01177-4. View

17.

Tan W, Ng W, Sultana R, de Souza N, Chew M, Foo F . Systematic review and meta-analysis of the use of serum procalcitonin levels to predict intra-abdominal infections after colorectal surgery. Int J Colorectal Dis. 2018; 33(2):171-180. DOI: 10.1007/s00384-017-2956-8. View

18.

Spoto S, Fogolari M, De Florio L, Minieri M, Vicino G, Legramante J . Procalcitonin and MR-proAdrenomedullin combination in the etiological diagnosis and prognosis of sepsis and septic shock. Microb Pathog. 2019; 137:103763. DOI: 10.1016/j.micpath.2019.103763. View

19.

Giaccaglia V, Salvi P, Antonelli M, Nigri G, Pirozzi F, Casagranda B . Procalcitonin Reveals Early Dehiscence in Colorectal Surgery: The PREDICS Study. Ann Surg. 2015; 263(5):967-72. DOI: 10.1097/SLA.0000000000001365. View

20.

van Dongen J, Smits F, van Santvoort H, Molenaar I, Busch O, Besselink M . C-reactive protein is superior to white blood cell count for early detection of complications after pancreatoduodenectomy: a retrospective multicenter cohort study. HPB (Oxford). 2020; 22(10):1504-1512. DOI: 10.1016/j.hpb.2020.02.005. View