Serum C-reactive protein level on first postoperative day can predict occurrence of postoperative pancreatic fistula after laparoscopic gastrectomy

Yamada, Shinichiro; Yagi, Shigehiko; Sato, Koichi; Shine, Mikiya; Sakamoto, Akimasa; Utsunomiya, Daichi; Okikawa, Shohei; Aibara, Norimasa; Watanabe, Miya; Obatake, Masayoshi; Ono, Riki; Fujii, Masahiko; Otani, Hiromi; Kawasaki, Hideki

doi:10.2152/jmi.66.285

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…Postoperative serum concentration of CRP is one of objective quantitative indices integrating the effects of preoperative comorbidities, surgical invasion, duration of surgery, anesthetic managements and analgesia [1,2]. Early increases in serum CRP concentrations after gastrointestinal surgery reportedly associate with postoperative complications [3][4][5][6][7][8][9][10] and cancer recurrence [11,12]. Therefore, perioperative managements aiming to prevent increases in CRP levels in the early postoperative period are relevant for better postoperative outcomes.…”

Section: Introductionmentioning

confidence: 99%

Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study

et al. 2020

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Background Postoperative serum concentration of C-reactive protein (CRP) is one of the objective quantitative indices integrating the effects of preoperative and intraoperative variables. Higher levels of CRP after gastrointestinal surgery are associated with major postoperative complications. To develop a model for predicting CRP levels on postoperative day (POD) 1 in surgical patients both with and without serious conditions and comorbidities, we modified the previous formula for prediction of CRP levels on POD1, and assessed the accuracy of our modified predictive formula for CRP levels. Material and methods Consecutive patients of all ages undergoing gastrointestinal surgery under general anesthesia were enrolled in this single-institution prospective cohort study. We developed a modified predictive formula in a calculation cohort. Next, associations between measured CRP levels on POD1, predicted CRP levels on POD1 using the previous and modified models, and major complications after surgery were examined in a validation cohort. Results We obtained the following model in the calculation cohort (n = 222): Modified model for predicting CRP levels on POD1 (mg•dL-1) =-10.13 + 0.0025 Duration of surgery (min) + 15.9 Mean Nociceptive Response (NR) + 0.66 Preoperative CRP level (mg•dL-1). In the validation cohort (n = 440), there was a significant association between measured and predicted CRP levels on POD1 (P < 0.001) No significant difference between the measured and predicted CRP levels using the modified model was observed (P = 0.847). There were also significant associations between the predicted CRP levels and major complications after surgery.

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Section: Introductionmentioning

confidence: 99%

Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study

et al. 2020

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“…When we examined previous reports, we found that Yamada et al reported that the risk of onset of severe POPF after gastrectomy increased when the C-reactive protein level on POD 1 was ≥ 3 mg/dL (OR=11.596, AUC 0.783) 11) , whereas Kamiya et al used D-AMY cut-off values of > 2118 U/L (AUC 0.855) on POD 1 and > 555 (AUC 0.818) on POD 3 12) . However, the only risk factor detected in our study was a D-AMY level ≥ 766 U/L on POD 2.…”

Section: Discussionmentioning

confidence: 92%

Total Drain Fluid Amylase Values Over Time Correlate with Late Complications of Pancreatic Fistulas after Gastrectomy

Shimada

Mikami

Hiwatari

et al. 2022

J St. Marianna Univ

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Introduction:The appropriate management of postoperative pancreatic fistula (POPF) after gastrectomy is believed to decrease the incidence of subsequent complications. Previous reports have indicated a relationship between subsequent complications of POPF and drain fluid amylase levels (D-AMY), but this indicator did not offer adequate sensitivity and specificity. In this study, we searched for indicators using highly precise D-AMY levels to predict the onset of subsequent complications. Materials and methods:We performed a retrospective study of 377 patients who underwent gastrectomy between 2014 and 2020 and whose D-AMY levels were measured. D-AMY levels were measured once a day, and we initiated treatment for pancreatitis if levels were ≥ 1500 U/L. We compared the incidence of complications and various clinical factors, including D-AMY level, and also strove to determine a clinically useful cut-off value. Results: There were 64 patients (17.0%) who were diagnosed as having pancreatitis by D-AMY levels ≥ 1500 U/L and required treatment. The significant risk factors were D-AMY ≥ 766 U/L on postoperative day (POD) 2 (p=0.0415, OR=32.46), and a total D-AMY of ≥ 6801 U/L from POD 0 to POD 4 (p=0.0023, OR=55.85). The area under the receiver operator characteristics curve, sensitivity and specificity were 0.84511, 78.6% and 90.9%, and 0.96834, 82.4% and 96.7% for the POD 2 and POD 0-4 cut-off values, respectively. Conclusion:The POD 2 cut-off value correlated with POPF complications after gastrectomy, but the concomitant use of the cut-off value for the period from POD 0-4 facilitated even more accurate prediction of subsequent onset of complications.

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Optimal Timing to Assess Drain Amylase Concentration after Elective Gastrectomy

et al. 2021

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Purpose While the amylase concentration of the drainage fluid (dAmy) has been reported to be a predictor of postoperative pancreas-related complications (PPRC), the optimal timing for its measurement has not been fully investigated. Materials and Methods The clinicopathological data of 387 patients who underwent elective gastrectomy for gastric cancer were reviewed. Laboratory data, including dAmy on postoperative days 1 (dAmy1) and 3 (dAmy3), and serum C-reactive protein (sCRP) concentrations on postoperative days 1 (sCRP1) and 3 (sCRP3) were compared between patients with PPRC and without PPRC. Results Nineteen of the 387 patients (4.9%) developed PPRC. The optimal cutoff values of dAmy1, dAmy3, sCRP1, and sCRP3 were 1514 IU/L, 761 IU/L, 8.32 mg/dL, and 15.15 mg/dL, respectively. The area under the curve of dAmy1 was greater than that of dAmy3 (0.915 vs. 0.826), and that of sCRP3 was greater than that of sCRP1 (0.820 vs. 0.659). In the multivariate analysis, dAmy1 (P<0.001) and sCRP3 (P=0.004) were significant predictors of PPRC, while dAmy3 (P=0.069) and sCRP1 (P=0.831) were not. Thirteen (41.9%) of 31 patients with both dAmy1 ≥1,545 IU/L and sCRP3 ≥15.15 mg/dL had PPRC ≥Clavien-Dindo II. In contrast, among 260 patients with both dAmy1 <1,545 IU/L and sCRP3 <15.15 mg/dL, none developed PPRC. Conclusions dAmy1 was more useful than dAmy3 in predicting PPRC. The combination of dAmy1 and sCRP3 may be a useful criterion for the removal of drains on postoperative day 3.

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Serum C-reactive protein level on first postoperative day can predict occurrence of postoperative pancreatic fistula after laparoscopic gastrectomy

Cited by 4 publications

References 25 publications

Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study

Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study

Total Drain Fluid Amylase Values Over Time Correlate with Late Complications of Pancreatic Fistulas after Gastrectomy

Optimal Timing to Assess Drain Amylase Concentration after Elective Gastrectomy

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