Abstract
BackgroundPresepsin is involved in binding lipopolysaccharides and previous studies have confirmed its value as a marker for early diagnosis and prediction of severity in sepsis. Comparable studies assessing the predictive potential regarding postoperative complications and mortality following pancreatic resection are lacking.MethodsThis prospective study included 70 patients undergoing pancreatic resection from December 2017 until May 2019. Presepsin was measured preoperatively, on postoperative day 1, 3 and 8 (POD1/3/8) and correlated with the clinical course and mortality.ResultsSevere complications (Clavien-Dindo ≥3a) occurred in 28 patients (40%), postoperative pancreatic fistula (POPF) grade B/C occurred in 20 patients (28.6%), infectious complications in 28 (40%), and four patients (5.7%) died during hospital stay. Presepsin levels at any timepoint did not correlate with further development of postoperative complications or in-hospital mortality whereas CRP levels on postoperative day (POD) 3 were significantly associated with clinically relevant POPF (AUC 0.664, 95%CI 0.528–0.800; p = 0.033). Preoperative Presepsin levels as well as Presepsin on POD1 were significantly elevated in patients with malignant compared to benign underlying disease (299pg/ml vs. 174pg/ml and 693.5pg/ml vs. 294pg/ml; p = 0.009 and 0.013, respectively).ConclusionIn our cohort, Presepsin was not eligible to predict the postoperative course following pancreatic resection. However, Presepsin levels were significantly elevated in patients with malignant disease, this finding warrants further investigation.
Highlights
Pancreatic resections (PR) are associated with significant morbidity and mortality
Severe complications (Clavien-Dindo 3a) occurred in 28 patients (40%), postoperative pancreatic fistula (POPF) grade B/C occurred in 20 patients (28.6%), infectious complications in 28 (40%), and four patients (5.7%) died during hospital stay
Presepsin levels at any timepoint did not correlate with further development of postoperative complications or inhospital mortality whereas C-reactive protein (CRP) levels on postoperative day (POD) 3 were significantly associated with clinically relevant Postoperative pancreatic fistula (POPF) (AUC 0.664, 95%CI 0.528–0.800; p = 0.033)
Summary
Pancreatic resections (PR) are associated with significant morbidity and mortality. Despite improvements in surgical technique, as well as peri- and postoperative care, mortality rates nowadays range between 2 and 5%, in most centres [1, 2]. Postoperative pancreatic fistula (POPF) represents one of the most frequent complications following PR, with a high variability in the literature ranging from 20% to 64% [4,5,6]. Other common complications include delayed gastric emptying (DGE), postoperative haemorrhage (PPH), or intra-abdominal fluid collections [7,8,9]. All of these complications are often accompanied by underlying infection, and in case of delayed detection or insufficient therapy are at high risk of potential sepsis and mortality [10, 11]. Comparable studies assessing the predictive potential regarding postoperative complications and mortality following pancreatic resection are lacking
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