The Change of Urea to Creatinine Ratio is Associated With Postoperative Complications and Skeletal Muscle Wasting in Pancreatic Cancer Patients Underwent Pancreatoduodenectomy

Abstract

BackgroundSurgical Patients with depleted skeletal muscle mass tend to have a worse outcome in the perioperative period, but the muscle mass is difficult to quantify. Here, we aimed to evaluate the relationship of perioperative change of serum urea to creatinine ratio (CUCR) with postoperative complication and skeletal muscle mass in pancreatic cancer patients underwent pancreatoduodenectomy (PD).MethodsPancreatic cancer patients underwent PD were included retrospectively. We analyzed the association of serum urea, creatinine, and urea to creatinine ratio (UCR) between patients with and without major postoperative complications. In a subset of patients with serial CT scans, we tested the correlation of the CUCR and the changes of CT-derived skeletal muscle area (SMA). Furthermore, the capacity of complication prediction of CUCR and CT-derived parameter were compared in these patients.ResultsWe included 321 surgical patients from January 2014 to July 2020. Patients were grouped with high- and low CUCR according ROC curve (cut-off: 71.3 for male and 67.4 for female). Patients with high CUCR (n=175) have higher complication rate (30.3% vs. 21.1%, p=0.002), including POPF (23.4% vs. 15.1%, p=0.017), infection rate (16.0% vs. 11.0%, p=0.043) and longer postoperative days to discharge (16.7±6.5, vs. 12.1±4.2, p=0.031). Multivariable logistic regression demonstrated CUCR was an independent predictor for complications in these patients, independent of age, sex and BMI. In a subset patients with serial CT scans, spearman correlation analysis shown both L3 muscle area and L4-psoas area were significantly correlated with CUCR (R2 = 0.64, p < 0.05; R2 = 0.62, p < 0.05, respectively). ConclusionPerioperative CUCR is an independent predictor for postoperative complications in pancreatic cancer patients underwent PD procedure. Elevated CUCR is a reflection of skeletal muscle wasting in postoperative surgical patients.

Urea-creatinine ratio (UCR) predicts the long-term prognosis of colorectal cancer patients after surgery

“…Our results were similar to a study based on pancreatic cancer patients undergoing surgery for PD (pancreatoduodenectomy), which found a higher incidence of postoperative complications in patients with elevated perioperative UCR for pancreatic cancer [31].…”

“…Although changes in renal function could affect the timing and extent of changes in BUN and Scr concentrations, their ratios are less affected because Scr and urea excretion also decrease with a reduced glomerular ltration rate. Therefore, UCR is a comprehensive and stable indicator that re ects muscle bioenergy failure, muscle catabolism, and alteration in protein homeostasis [13,31,32]. In the present study, we found that preoperative BUN was elevated, and preoperative Scr was signi cantly decreased in patients with a poorer 3year prognosis of patients enrolled.…”

Incidence and Management of Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy in Management of Periampullary Cancer: A Single Center Study

“…Duan and his colleagues, (2021), found in their study that post-operatively there was increase in the renal function tests which significantly related with occurrence of post-operative complications which disagree with our results [18].…”

Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China

“…Muscle protein loss in critically ill patients has been demonstrated to be associated with various adverse outcomes. [ [186] , [187] , [188] ] Several studies have shown that elevated UCR levels are significantly associated with impaired organ function, infectious complications, prolonged ICU or total hospitalization, [ 189 ] and even increased mortality. [ 180 , 184 , 185 ] Therefore, UCR, as a simple, cost-effective, and accurate marker of catabolism, is extremely convenient to be used for dynamic monitoring of muscle protein during the treatment of ICU patients with high catabolism.…”

“…Haines et al [ 180 ] found a rapid decline in muscle mass and a significant negative correlation between UCR and the rate of muscle loss in 53 critically ill patients with data from serial CT scanning tests by assessing the L3 and L4 psoas major CSA ( R 2 =0.39, P <0.001 and R 2 =0.44, P <0.001). In a study of 321 patients operated for pancreatic cancer, [ 189 ] elevated UCR accurately reflected skeletal muscle atrophy in postoperative surgical patients. Meanwhile, multifactorial logistic regression showed that UCR was an independent predictor of postoperative complications in patients (OR=1.89, 95% CI: 1.52 to 2.14, P =0.015).…”