title: Limited utility of inflammatory markers in the early detection of postoperative inflammatory complications after pancreatic resection: Cohort study and meta-analyses.
abstract: OBJECTIVE
  To examine the diagnostic accuracy of systemic inflammatory markers in early prediction of inflammatory postoperative complications (IPC) and clinically-relevant pancreatic fistula (PF).
  
  
  METHODS
  Preoperative and postoperative [until postoperative day (POD) 4)] measurements of hemoglobin, white blood cell counts (WBC), neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) were correlated with IPC and PF. Meta-analyses of biochemical predictors were performed.
  
  
  RESULTS
  Ninety-two out of 378 patients developed IPC, PF occurred in 31. Preoperative WBC (OR 1.0001, 95% CI: 1.0001-1.0002, p = 0.02), NLR on POD2 (OR 1.05, 95% CI: 1.006-1.1, p = 0.02) and CRP on POD4 (OR 1.006, 95% CI: 1.002-1.01, p = 0.02) predicted IPC at multivariate analysis. The model including these three variables showed a diagnostic accuracy of 76.8% (sensitivity 20, specificity 97%.14; PPV 71.43, PPN 77.27) and, at logistic regression analysis an OR of 8.5 (95% CI: 2.5-28.6, p < 0.001). Only CRP >272 on POD3 (OR 3.32, 95% CI: 1.46-7.52, p = 0.003) was associated with PF with a diagnostic accuracy of 74% (sensitivity 54.5, specificity 78.5; PPV 16.88, NPV 94.25). Meta-analyses of available data suggested sensitivity of 75.3% (95% CI 66.7-82.6) and specificity of 75.5% (95% CI 61.3-85.7). However, these studies were significantly heterogeneous.
  
  
  CONCLUSIONS
  Readily available, routine tests have limited utility in predicting IPC. Further research is required to develop novel biomarkers to aid management of these patients.
authors.affiliation: Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Solaini
authors.affiliation: Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Bambang T
authors.initials: BT
authors.lastname: Atmaja
authors.affiliation: Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Watt
authors.affiliation: Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Prabhu
authors.initials: P
authors.lastname: Arumugam
authors.affiliation: Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Hutchins
authors.affiliation: Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Ajit T
authors.initials: AT
authors.lastname: Abraham
authors.affiliation: Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Satyajit
authors.initials: S
authors.lastname: Bhattacharya
authors.affiliation: Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, UK. Electronic address: h.kocher@qmul.ac.uk.
authors.forename: Hemant M
authors.initials: HM
authors.lastname: Kocher
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D042241:Early Diagnosis; D005500:Follow-Up Studies; D006801:Humans; D010180:Pancreatectomy / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis*; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: C-reactive protein; Inflammatory markers; Meta-analysis; Pancreas surgery; Pancreatic fistula; Postoperative complications