The novel early predictive marker presepsin for postoperative pancreatic fistula: A pilot study
Masatsugu Hiraki1, Atsushi Miyoshi1, Eiji Sadashima2
1Department of Surgery, Saga Medical Center Koseikan, Saga 840-8571, Japan.
Insights
A novel biomarker, presepsin in drainage fluid, can predict clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). This finding offers a new tool for early detection and management of this serious complication.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Biomarker Discovery
Background:
- Postoperative pancreatic fistula (PF) is a significant complication following pancreaticoduodenectomy (PD).
- Accurate prediction of clinically relevant PF (CR-POPF) is crucial for patient management.
- Novel biomarkers are needed to improve early detection of CR-POPF.
Purpose of the Study:
- To evaluate presepsin as a novel biomarker for predicting CR-POPF after PD.
- To identify risk factors associated with CR-POPF.
- To assess the diagnostic performance of presepsin in drainage fluid and serum.
Main Methods:
- Prospective pilot study of 30 patients undergoing PD.
- Statistical analysis of risk factors and potential biomarkers.
- Measurement of serum and drainage fluid presepsin levels on postoperative day 1 (POD1).
- Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression.
Main Results:
- CR-POPF occurred in 50% of patients.
- Factors like non-pancreatic cancer, smaller pancreatic ducts, and soft pancreas texture were associated with CR-POPF.
- Elevated serum amylase, serum presepsin, and drainage fluid presepsin on POD1 were significantly higher in CR-POPF cases.
- Drainage fluid presepsin concentration was an independent predictor of CR-POPF (OR, 14.503; P=0.013).
Conclusions:
- Presepsin concentration in drainage fluid is a promising and independent predictive marker for CR-POPF after PD.
- This study is the first to demonstrate the utility of drainage fluid presepsin for CR-POPF prediction.
- Early identification of CR-POPF using presepsin may facilitate timely intervention and improve outcomes.
Abstract:
Postoperative pancreatic fistula (PF) is a major and serious complication that occurs after pancreaticoduodenectomy (PD). The aim of the current study was to evaluate the use of a novel biomarker, presepsin, for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after PD. A prospective pilot study was conducted using 30 consecutive patients who underwent PD. Risk factors and candidates for predictive biomarkers for CR-POPF were statistically analyzed. CR-POPF (grade B and C; determined according to the guidelines of the International Study Group of Pancreatic Fistula) occurred in 15 patients (50%). Univariate analysis revealed that certain underlying conditions, including non-pancreatic cancer, smaller pancreatic ducts and soft pancreas texture were significantly associated with CR-POPF (P=0.005, P=0.004 and P=0.014, respectively). Furthermore, on day 1 post surgery (POD1), white blood cell count (P=0.040), levels of serum amylase (P=0.002) and serum presepsin (P=0.012), and the concentration of presepsin in drainage fluid (P<0.001) were significantly increased in CR-POPF compared with non-CR-POPF cases. Receiver operating characteristic curve analyses revealed that, on POD1, serum amylase and the concentration of presepsin in drainage fluid had an area under the curve value exceeding 0.8. A multivariate logistic regression analysis revealed that a higher concentration of presepsin in the drainage fluid was an independent predictive marker for CR-POPF (odds ratio, 14.503; 95% confidence interval, 1.750-120.229; P=0.013). To the best of our knowledge, the present study demonstrated for the first time that presepsin concentration in drainage fluid is a useful marker of CR-POPF after PD.
