Postoperative reactive C protein associated with morbidity (gastroparesis and fistula) after whipple procedure

Abstract

Introduction: Early postoperative biomarkers (C reactive protein PCR, procalcitonin PCT, arterial lactate) analysis for prediction of morbidity after pancreatoduodenectomy (PD). Methods: Prospective case-control analysis of consecutive PD performed during 2015, 2016 and 2017 at the Rio-Hortega University Hospital, Valladolid, Spain. Main outcomes: overall morbidity (OM), Clavien ≥III morbidity, surgical site infection (SSI). Secondary outcomes: gastroparesis, pancreatic fistula (PF), hemorrhage (according to ISGPS: no appearance versus grades A, B and C). Mean values of RCP, PCT and arterial lactate (obtained from morning blood samples on first and second postoperative days [POD1, POD2]) were compared among cases (appearance of complication) and control patients (without complication). ROC curves and AUC were obtained. Statistics: SPSS 24. Results: 41 patients (age 64.1 ± 10.5 years, 61% males). Rates of OM, Clavien ≥III morbidity, SSI, gastroparesis, PF, hemorrhage were respectively: 87.8%, 34.1%, 19.5%, 37.5%, 26.8%, 24.4%, respectively. For OM, PCT-POD1 and Lactate-POD1 lower among controls (0.33 versus 1.49 p = 0.02, 1.31 versus 1.81 p = 0.08). For gastroparesis, PCR-POD2 was lower among controls (177 versus 264 p = 0.005). For PF, PCR-POD2 and Lactate-POD2 were lower among controls (186 versus 278 p = 0.005, 1.2 versus 1.5 p = 0.003). No biomarker was associated with Clavien ≥III complications or hemorrhage. AUC were highest for PCT-POD1 (0.816, 95% CI = 0.655–0.976 p = 0.01) and PCR-POD2 (gastroparesis: 0.772, 95% CI = 0.628–0.916 p = 0.004; PF: 0.753, 95% CI = 0.57–0.935 p = 0.014). Conclusion: Increased PCT-POD1 is associated to OM as well as increased PCR-POD2 to gastroparesis and PF. They should be determined during early postoperative period in patients undergoing PD.