Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy

Abstract

BACKGROUND The available prediction models for clinically relevant postoperative pancreatic fistula (CR-POPF) do not incorporate both preoperative and intraoperative variables. AIM To construct a new risk scoring system for CR-POPF that includes both preoperative and intraoperative factors. METHODS This was a retrospective study of patients who underwent pancreaticoduodenectomy (PD) or pylorus-preserving PD (PPPD) between January 2011 and December 2016 at the First Affiliated Hospital of Soochow University. Patients were divided into a study (01/2011 to 12/2014) or validation (01/2015 to 12/2016) group according to the time of admission. POPF severity was classified into three grades: Biochemical leak (grade A) and CR-POPF (grades B and C). Logistic regression was used to create a predictive scoring system. RESULTS Preoperative serum albumin ≥ 35 g/L [ P = 0.032, odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.85-0.99], hard pancreatic texture ( P = 0.004, OR = 0.25, 95%CI: 0.10-0.64), pancreatic duct diameter ≥ 3 mm ( P = 0.029, OR = 0.50, 95%CI: 0.27-0.93), and intraoperative blood loss ≥ 500 mL ( P = 0.006, OR = 1.002, 95%CI: 1.001-1.003) were independently associated with CR-POPF. We established a 10-point risk scoring system to predict CR-POPF. The area under the curve was 0.821 (95%CI: 0.736-0.905) and the cut-off value was 3.5. Including drain amylase levels improved the predictive power of the model. CONCLUSION This study established a 10-point scoring system to predict CR-POPF after PD/PPPD using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high- and low-risk populations in order to facilitate timely interventions after PD.

Risk Factors and a New Prediction Model for Pancreatic Fistula After Pancreaticoduodenectomy

“…Previous studies analyzed risk factors for POPF and developed risk prediction tool using scoring system. 22,[36][37][38][39][40] However, few studies have built a nomogram based on individual risk factors. After our extensive review, only one study has tried to develop a nomogram for the prediction of POPF.…”

The Risk Prediction Model for Healthcare-Associated Infections among Elderly Patients Underwent Pancreaticoduodenectomy

“…Based on the univariate analysis, the risk prediction model using BP-ANN involving 9 significant factors for predicting HAI occurrence among elderly PD patients was finally constructed. The overall prediction accuracy of the model, 93.79%, was obviously higher than the reported predictive rate of 75.7% conducted in lung cancer patients [32] and 82.49% conducted among hematological diseases patients [41], and also higher than the reported predictive performance conducted by 10-point Braga risk score among patients underwent PD [28]. It had indicated that BP neural network prediction accuracy could reach approximately 90% by scientifically determining risk indicators and constructing appropriate network models [42], which was well verified in this study.…”

“…Joliat GR et al applied the Braga score to calculate the overall risk score for the prediction of complications after PD [27]. A risk scoring system with 10-point based on logistic regression was also established to predict the pancreatic fistula [28]. However, most of studies mainly focused on general age groups, and just described one or more postoperative complications rather than targeting HAIs.…”

Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

“…For most preoperative and intraoperative static indexes, our result shows that only a few of them could predict the occurrence of CR-POPF, apart from preoperative serum albumin and creatine levels. This is possibly due to the fact that there's still no strong consensus about the association between these factors and CR-POPF, which probably leads to the inconsistencies in the prediction models developed recently [9,10,16,18]. However, we noted that the patients who developed CR-POPF tend to have an advanced age [44,45], higher BMI [46,47], softer pancreas [48][49][50], and smaller pancreatic ducts [48,[51][52][53][54][55], were less likely to have diabetes [47,56], and were more likely to have had portal vein resection [57], which are comparable to findings of previous research.…”

“…Among them, postoperative drainage fluid amylase (DFA) and C-reactive protein-to-serum-albumin ratio (CAR) seemed to be the accurate and widely used indexes for the prediction of CR-POPF, especially in a particular time-point, in which they are suggested to be useful and critical predictive indexes [11][12][13][14]. However, preoperative and intraoperative factors indicating CR-POPF seemed to vary [15][16][17][18], furthermore, such prediction result cannot be updated according to the changes in the patient's fluctuating state and examination results over time.…”