Novel diagnostics for aggravating pancreatic fistulas at the acute phase after pancreatectomy
Novel diagnostics for aggravating pancreatic fistulas at the acute phase after pancreatectomy
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DOI：
10.3748/wjg.v20.i26.8535
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发表时间：
2014-07-14
影响因子：
4.3
通讯作者：
Kodera, Yasuhiro
中科院分区：
文献类型：
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作者：
Kanda, Mitsuro;Fujii, Tsutomu;Kodera, Yasuhiro
目的：为了确定胰腺切除术后急性期临床相关术后胰瘘（POPF）的敏感预测因素，本研究纳入了153例在2008年1月至2013年3月期间在开放性胰腺切除术或远端胰腺切除术后术后第3天（POD）诊断为POPF的患者。根据国际胰瘘定义研究组将POPF分为3个等级，认为B或C级POPF具有临床相关性。POD 1、3和5时临床相关POPF形成值的预测性能以及炎症标志物水平的时间依赖性变化，包括白色血细胞计数、中性粒细胞计数、总淋巴细胞计数、C-反应蛋白（CRP）、降钙素原水平、血小板-淋巴细胞比率和嗜中性粒细胞-淋巴细胞比率，采用受试者工作特征（ROC）曲线和多变量分析比较引流液中淀粉酶含量。使用本研究中确定的五个风险因素，其诊断性能也evaluated.RESULTS：随着时间的推移，77（50%）的153例入组患者的预测临床相关的POPFs的评分系统，并被归类为具有临床相关的POPFs。ROC曲线分析显示，从POD 1至POD 3的CRP水平变化具有最大的曲线下面积值（0.767），并且CRP水平升高28.4 mg/L产生了临床相关POPF的最佳预测值。临床相关POPF危险因素的多变量分析确定胰腺浸润性癌和CRP水平升高（>= 28.4 mg/L，从POD 1至POD 3）作为临床相关POPF的独立诊断因素（OR 2.94，95%CI：1.08-8.55，P = 0.035和OR 4.82，95%CI：1.25-20.2，P = 0.022）。证实了临床相关POPF的患病率与风险分类评分成比例逐渐增加。CRP水平的高度升高和风险评分>= 8与引流管放置时间和术后住院时间的延长显著相关。结论：血清CRP水平从POD 1到POD 3的急剧升高是随后临床相关POPF的高度预测因素。(C)2014百世登出版集团股份有限公司All rights reserved.
AIM: To identify sensitive predictors of clinically relevant postoperative pancreatic fistula (POPF) at the acute phase after pancreatectomy.METHODS: This study included 153 patients diagnosed as having POPFs at postoperative day (POD) 3 after either open pancreatoduodenectomy or distal pancreatectomy between January 2008 and March 2013. The POPFs were categorized into three grades based on the International Study Group on Pancreatic Fistula Definition, and POPFs of grades B or C were considered to be clinically relevant. The predictive performance for the clinically relevant POPF formation of values at PODs 1, 3 and 5 as well as time-dependent changes in levels of inflammatory markers, including white blood cell count, neutrophil count, total lymphocyte count, C-reactive protein (CRP), procalcitonin level, platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio, and amylase content in the drain fluid were compared using the receiver operating characteristic (ROC) curve and multivariable analyses. A scoring system for the prediction of clinically relevant POPFs was created using five risk factors identified in this study, and its diagnostic performance was also evaluated.RESULTS: Over time, 77 (50%) of 153 enrolled patients followed a protracted course and were categorized as having clinically relevant POPFs. ROC curve analyses revealed that changes in CRP levels from POD 1 to POD 3 had the greatest area under the curve value (0.767) and that an elevated CRP level of 28.4 mg/L yielded the most optimal predictive value for clinically relevant POPFs. Multivariable analyses for the risk factors of clinically relevant POPFs identified invasive carcinomas of the pancreas and elevation of the CRP level (>= 28.4 mg/L, from POD 1 to POD 3) as independent diagnostic factors for clinically relevant POPFs (OR 2.94, 95%CI: 1.08-8.55, P = 0.035 and OR 4.82, 95%CI: 1.25-20.2, P = 0.022, respectively). A gradual increase in the prevalence of clinically relevant POPFs in proportion to the risk classification score was confirmed. A highly elevated CRP level and a risk score >= 8 were significantly associated with a prolonged duration of drain placement and postoperative hospitalization.CONCLUSION: A steep rise in the serum CRP level from POD 1 to POD 3 was a highly predictive factor for subsequent clinically relevant POPFs. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.