Postoperative elevation of C-reactive protein levels and high drain fluid amylase output are strong predictors of pancreatic fistulas after distal pancreatectomy

Abstract

Background: The aim of the present study was to identify the predictors of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP).

Methods: The records of 97 consecutive patients who underwent DP at Ehime University Hospital between June 2009 and August 2020 were retrospectively reviewed. Patient characteristics, preoperative blood biochemistry data, operative findings, and postoperative findings until postoperative day (POD) 3 were investigated as potential predictors of clinically relevant POPF (CR-POPF). The product of the drain fluid amylase (DFA) value (U/L) and the drainage amount (mL/day) was defined as DFA output (U/day).

Results: Of 97 patients who underwent DP, 23 (23.7%) developed CR-POPF. On multivariate analyses, high C-reactive protein (CRP) levels on POD 3 (>14.0 mg/dL) and high DFA output on POD 3 (>34 U/day) were found to be independent predictors of CR-POPF (odds ratios, 7.580 and 4.751, respectively; 95% confidence intervals, 2.052-27.995 and 1.487-15.175, respectively). Furthermore, the CRP value was helpful for predicting delayed CR-POPF in patients without POPF on POD3, and DFA output was useful for predicting the development of CR-POPF in patients diagnosed with POPF on POD3.

Conclusion: Postoperative CRP values and DFA output may facilitate appropriate postoperative management after DP.

Keywords: C-reactive protein; distal pancreatectomy; drain fluid amylase; postoperative pancreatic fistula.