The clinical value of C-reactive protein and procalcitonin in early prediction of pancreatic fistula after pancreaticoduodenectomy

Abstract

Objective To study the relationship of early postoperative CRP and PCT with pancreatic fistula after pancreaticoduodenectomy (PD); to study whether the combination of CRP and PCT can be used as an early predictor of pancreatic fistula; and to determine the optimal cut-off values of CRP and PCT for early diagnosis of pancreatic fistula after PD. Methods Postoperative pancreatic fistula and other complications were recorded in 82 patients after PD carried out at the Anshan Iron and Steel Group General Hospital from January 2013 to May 2017. PCT and CRP were measured on the 1st to the 5th postoperative day (POD). CRP and PCT were compared between the pancreatic fistula group and the non-complication group on pancreatic fistula prediction. The sensitivity, specificity, and combined sensitivity, combined specificity, negative predictive value, positive predictive value and optimal cut-off value were calculated. Results 56 patients developed postoperative complications, including 17 patients with pancreatic fistula, and 39 patients with non-pancreatic fistula. The postoperative CRP and PCT were correlated with postoperative pancreatic fistula and with other complications. The higher the CRP and PCT, the higher the risk of postoperative pancreatic fistula. The ROC curves suggested that CRP and PCT had a high predictive value for pancreatic fistula, especially on POD 2. The optimal cut-off value of CRP was 189.05 mg/L, the sensitivity was 94.1%, the specificity was 81.5%, the positive predictive value was 94.7%, and the negative predictive value was 24.4%. The optimal cut-off value of PCT was 0.89 mg/dl, the sensitivity was 88.2%, the specificity was 84.6%, the positive predictive value was 91.3%, and the negative predictive value was 20.5%. The sensitivity and specificity of combined CRP with PCT on POD 2 in predicting pancreatic fistula after operations were 100% and 69.1%, respectively. Conclusion Combined CRP and PCT had a high early predictive rate in the identification of pancreatic fistula after PD. Key words: Pancreaticoduodenectomy; Postoperative pancreatic fistula; C-reactive protein; Procalcitonin; Predictor