Postoperative C-reactive protein as a predictor of postoperative pancreatic fistula and hospital readmission following pancreaticoduodenectomy

Abstract

Introduction: Postoperative pancreatic fistula (POPF) is the Achilles heel following Pancreaticoduodenectomy (PD).Early prediction of POPF has direct influence on patient management and outcome. This study aimed at identifying role of C-reactive protein (CRP) on first postoperative day (POD1) as predictor of clinically relevant pancreatic fistula (CR-POPF) and at discharge as a predictor of hospital readmission. Methods: A prospective observational quantitative study was performed on 49 patients over one year who underwent PD. Clinical, biochemical, intraoperative and pathological characteristics were recorded. Quantitative serum CRP was sent on POD1 and at discharge. POPF was graded according to International Study Group in Pancreatic Surgery 2016.Diagnostic accuracy of CRP on POD1 to predict CR-POPF and at discharge to predict 90 day readmission were assessed by Receiver Operating Characteristics (ROC) curve analysis and cut-off value of CRP was calculated. Results: Overall morbidity was 57.1% with mortality of 4.1%.Bile leak occurred in 38.8%.CR-POPF developed in 26.5% and cholangitis was independent risk factor(p< 0.05). Readmission rate was 14.3%. ROC curve analysis showed POD1 CRP level >100mg/l as a predictor of CR-POPF (AUC: 0.687; 95%CI [0.522-0.852] and CRP>50mg/L at discharge as a significant predictor of hospital readmission (AUC: 0.807 (95%CI [0.607-0.100], p< 0.05). Conclusion: CRP is a reliable predictor of CR-POPF and hospital readmission, thus should be utilized in patient management. Keywords: C-reactive protein; Pancreaticoduodenectomy, Postoperative pancreatic fistula; Readmission