title: Novel diagnostics for aggravating pancreatic fistulas at the acute phase after pancreatectomy.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  A steep rise in the serum CRP level from POD 1 to POD 3 was a highly predictive factor for subsequent clinically relevant POPFs.
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Takami
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Suenaga
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Inokawa
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Tanaka
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koike
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Michitaka
authors.initials: M
authors.lastname: Fujiwara
authors.affiliation: Mitsuro Kanda, Tsutomu Fujii, Hideki Takami, Masaya Suenaga, Yoshikuni Inokawa, Suguru Yamada, Daisuke Kobayashi, Chie Tanaka, Hiroyuki Sugimoto, Masahiko Koike, Shuji Nomoto, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein
keywords: C-reactive protein; Inflammatory marker; Pancreatectomy; Pancreatic fistula; Prediction