Serum Blood Urea Nitrogen and Serum Albumin on the First Postoperative Day Predict Pancreatic Fistula and Major Complications After Pancreaticoduodenectomy
Serum Blood Urea Nitrogen and Serum Albumin on the First Postoperative Day Predict Pancreatic Fistula and Major Complications After Pancreaticoduodenectomy
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DOI：
10.1007/s11605-012-2093-1
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发表时间：
2013-02-01
影响因子：
3.2
通讯作者：
Berger, Adam C.
中科院分区：
文献类型：
--
作者：
Relles, Daniel M.;Richards, Nathan G.;Berger, Adam C.
胰十二指肠切除术（PD）发病率高。先前的研究表明，术后第1天（POD）的低白蛋白血症是导致食管切除术后并发症的原因之一。我们开始确定血液尿素氮（BUN）和白蛋白对PD患者POD 1的影响。我们对2000年1月1日至2008年12月31日期间在托马斯·杰斐逊大学医院连续接受PD治疗的446例患者进行了研究。采用Clavien量表对并发症进行分级。我们检查了基于POD 1白蛋白< 2.5与千分之一日元2.5 mg/dl，以及POD 1 BUN < 10与千分之一日元10 g/dl的并发症发生率。BUN < 10的患者出现任何并发症（p < 0.001）、严重并发症（p < 0.001）和胰瘘（p = 0.011）的风险均显著降低。多因素分析显示，BUN a / 1000 / yna和euro / 1000 / 10是III级及以上并发症（p = 0.0019，危险比(HR) = 2.7）和胰瘘（p = 0.016, HR = 2.6）的最显著预测因子。POD 1白蛋白< 2.5 mg/dl也是严重并发症的独立预测因子（p = 0.01, HR = 2.3）。有这两种危险因素的患者发生严重并发症的几率为31%，发生胰瘘的几率为18.5%，而没有这两种危险因素的患者发生胰瘘的几率分别为6.5%和3.6%。血清白蛋白和BUN是PD术后围手术期发病率的重要预测指标。这些低成本和容易获得的测试可以作为预测不良手术结果的预后工具。
Pancreaticoduodenectomy (PD) has a high morbidity rate. Previous work has shown that hypoalbuminemia on postoperative day 1 (POD) to be contributory to post-esophagectomy complications. We set out to determine the impact of blood urea nitrogen (BUN) and albumin on POD 1 for patients undergoing PD.We examined 446 consecutive patients who underwent PD at the Thomas Jefferson University Hospital between January 1, 2000 and December 31, 2008. Complications were graded using the Clavien scale. We examined the incidence of complications based on POD 1 albumin < 2.5 versus a parts per thousand yen2.5 mg/dl, as well as POD 1 BUN < 10 vs. a parts per thousand yen10 g/dL.Patients with a BUN < 10 had a significantly decreased risk of any complication (p < 0.001), serious complication (p < 0.001), and pancreatic fistula (p = 0.011). On multivariate analysis, BUN a parts per thousand yenaEuro parts per thousand 10 was the most significant predictor of grade III or above complication (p = 0.0019, hazard ration (HR) = 2.7) and pancreatic fistula (p = 0.016, HR = 2.6). POD 1 albumin < 2.5 mg/dl was also an independent predictor of serious complication (p = 0.01, HR = 2.3). Patients with both risk factors had a 31 % chance of developing serious complications and 18.5 % risk of developing pancreatic fistula, while those patients with neither risk factor had a 6.5 and 3.6 % risk, respectively.Serum albumin and BUN on POD 1 are important predictors of perioperative morbidity following PD. These low-cost and easily accessible tests can be used as a prognostic tool to predict adverse surgical outcomes.