C-reactive protein is superior to white blood cell count for early detection of complications after pancreatoduodenectomy: a retrospective multicenter cohort study. Issue 10 (October 2020)

• Record Type: Journal Article
• Authors: van Dongen, Jelle C.; Smits, F. Jasmijn; van Santvoort, Hjalmar C.; Molenaar, I. Quintus; Busch, Olivier R.; Besselink, Marc G.; Aziz, M. Hossein; Groot Koerkamp, Bas; van Eijck, Casper H.J.
• Is Part Of: HPB. Volume 22:Issue 10(2020)
• Page Start: 1504
• Page End: 1512
• Publication Date: 2020-10
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2020.02.005
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: 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.