Evaluating C-Reactive Protein in Drainage Fluid as a Predictive Biomarker for Clinically Relevant Pancreatic Fistulas...

This study was conducted to determine the use of C-reactive protein (CRP) levels in drainage fluid as an alternative indicator of clinically relevant postoperative pancreatic fistulas (CR-POPFs) following pancreaticoduodenectomy (PD). Reportedly, serum CRP levels are associated with CR-POPFs. Drainage fluid following PD is used to diagnose a pancreatic fistula, removing the need for blood sampling. However, the significance of CRP in drainage fluid remains unclear.

In this retrospective study, we reviewed consecutive patients who underwent PD at Hiroshima University between April 2014 and October 2021. Clinical factors for CR-POPFs were analyzed, and serum and drain CRP levels were measured during the first 4 days after surgery.

Among the 384 patients enrolled, 58 (15.1%) developed CR-POPFs. Serum and drain CRP levels on postoperative days (PODs) 2, 3, and 4 were significantly associated with CR-POPFs. Receiver operating characteristic analysis indicated that CRP levels on POD 4 most precisely predicted CR-POPFs, with area under the curve values of 0.820 and 0.803 for serum and drain CRP levels, respectively. Additionally, these two factors exhibited a strong positive correlation (p<0.001, r=0.814). Multivariate analysis revealed that drain CRP level ≥6.5 mg/dL on POD 4 independently predicted CR-POPFs (odds ratio 4.95; 95% confidence interval 2.27-10.81; p<0.001) with a negative predictive value of 95.6%.

Drain CRP level on POD 4 is a strong predictive factor for CR-POPFs and may be an alternate criterion to serum CRP levels after PD.