C-reactive protein is superior to white blood cell count for early detection of complications after pancreatoduodenectomy: a retrospective multicenter cohort study,HPB

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C-reactive protein is superior to white blood cell count for early detection of complications after pancreatoduodenectomy: a retrospective multicenter cohort study
HPB ( IF 2.7 ) Pub Date : 2020-03-11 , DOI: 10.1016/j.hpb.2020.02.005
Jelle C van Dongen ₁ , F Jasmijn Smits ₂ , Hjalmar C van Santvoort ₃ , I Quintus Molenaar ₂ , Olivier R Busch ₄ , Marc G Besselink ₄ , M Hossein Aziz ₁ , Bas Groot Koerkamp ₁ , Casper H J van Eijck ₁ ,

Affiliation

Background

Early detection of major complications after pancreatoduodenectomy could improve patient management and decrease the “failure-to-rescue” rate. In this retrospective cohort study, we aimed to compare the value of C-reactive protein (CRP) and white blood cell count (WBC) in the early detection of complications after pancreatoduodenectomy.

Methods

We assessed pancreatoduodenectomies between January 2012 and December 2017. Major complications were defined as grade III or higher according to the Clavien-Dindo classification. Postoperative pancreatic fistula (POPF) was a secondary endpoint. ROC-curve and logistic regression analysis were performed for CRP and WBC. Results were validated in an external cohort.

Results

In the development cohort (n = 285), 103 (36.1%) patients experienced a major complication. CRP was superior to WBC in detecting major complications on postoperative day (POD) 3 (AUC:0.74 vs. 0.54, P < 0.001) and POD 5 (AUC:0.77 vs. 0.68, P = 0.031), however not on POD 7 (AUC:0.77 vs. 0.76, P = 0.773). These results were confirmed in multivariable analysis and in the validation cohort (n = 202). CRP was also superior to WBC in detecting POPF on POD 3 (AUC: 0.78 vs. 0.54, P < 0.001) and POD 5 (AUC: 0.83 vs. 0.71, P < 0.001).

Conclusion

CRP appears to be superior to WBC in the early detection of major complications and POPF after pancreatoduodenectomy.

中文翻译：

在胰十二指肠切除术后早期发现并发症方面，C 反应蛋白优于白细胞计数：一项回顾性多中心队列研究

背景

早期发现胰十二指肠切除术后的主要并发症可以改善患者管理并降低“抢救失败”率。在这项回顾性队列研究中，我们旨在比较 C 反应蛋白 (CRP) 和白细胞计数 (WBC) 在胰十二指肠切除术后并发症的早期检测中的价值。

方法

我们评估了 2012 年 1 月至 2017 年 12 月期间的胰十二指肠切除术。根据 Clavien-Dindo 分类将主要并发症定义为 III 级或更高级别。术后胰瘘 (POPF) 是次要终点。对 CRP 和 WBC 进行 ROC 曲线和逻辑回归分析。结果在外部队列中得到验证。

结果

在开发队列 (n = 285) 中，103 名 (36.1%) 患者出现严重并发症。CRP 在术后第 3 天（AUC：0.74 对 0.54，P < 0.001）和 POD 5（AUC：0.77 对 0.68，P = 0.031）检测主要并发症方面优于 WBC，但在 POD 7 时则不然（ AUC：0.77 与 0.76，P = 0.773）。这些结果在多变量分析和验证队列（n = 202）中得到证实。CRP 在检测 POD 3（AUC：0.78 对 0.54，P < 0.001）和 POD 5（AUC：0.83 对 0.71，P < 0.001）的 POPF 方面也优于 WBC。