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C-reactive protein identifies patients at risk of postpancreatectomy hemorrhage
C Vilhav1, J B Fagman2, E Holmberg2
1Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. caroline.vilhav@gu.se.
Insights
High postoperative C-reactive protein (CRP) levels are linked to an increased risk of postpancreatectomy hemorrhage grade C (PPH C), a serious complication following pancreaticoduodenectomy (PD). Recognizing these predictive factors is crucial for patient outcomes.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Critical Care Medicine
Background:
- Postpancreatectomy hemorrhage grade C (PPH C) is a severe complication after pancreaticoduodenectomy (PD), associated with high mortality.
- Predictive factors for PPH C remain challenging to identify.
- The relationship between postoperative pancreatic fistulas (POPF) and PPH C is established, but POPF is often not diagnosed before hemorrhage occurs.
Purpose of the Study:
- To identify potential predictive factors for PPH C in patients undergoing PD.
- To investigate the correlation between preoperative, perioperative, and postoperative data and the development of PPH C.
Main Methods:
- A retrospective study included 517 patients who underwent PD between 2003 and 2018.
- Twenty-three patients with PPH C were identified and matched with 92 control patients.
- Preoperative, perioperative, and postoperative variables, including C-reactive protein (CRP), were analyzed.
Main Results:
- Elevated postoperative CRP levels (median 140 mg/L on day 5 or 6) were significantly correlated with PPH C (p < 0.05).
- Postoperative drain amylase levels did not show clinical relevance for PPH C occurrence.
- Grade C POPF or biliary leak was present in most PPH C patients, but the source of the leak was not identified before bleeding.
Conclusions:
- High postoperative CRP levels are associated with an increased risk of PPH C.
- Early identification of elevated CRP may aid in predicting PPH C risk after PD.
Background:
Postpancreatectomy hemorrhage grade C (PPH C) is a dreaded complication after pancreaticoduodenectomy (PD) with high mortality rate. Concurrent risk factors for PPH C have been difficult to recognize. Connection between postoperative pancreatic fistulas (POPF) and PPH C is well known, but POPF is often unknown prior to the PPH. The aim of this retrospective study was to define potential predictive factors for PPH C.
Methods:
Retrospectively, 517 patients who underwent PD between 2003 and 2018 were included in the study. Twenty-three patients with PPH C were identified, and a matched control group of 92 patients was randomly selected. Preoperative data (body mass index, cardiovascular disease, history of abdominal surgery, biliary stent, C-reactive protein (CRP), ASA-score), perioperative data (bleeding, pancreatic anastomosis, operation time), and postoperative data (CRP, drain amylase, POPF, biliary fistula) were analyzed as potential predictors of PPH C.
Results:
High postoperative CRP (median 140 mg/L on day 5 or 6) correlated with the development of PPH C (p < 0.05). Postoperative drain amylase levels were not clinically relevant for occurrence of PPH C. Grade C POPF or biliary leak was observed in the majority of the PPH C patients, but the leaking anastomoses were not detected before the bleeding started.
Discussion:
High postoperative CRP levels are related to an increased risk of PPH C.
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