Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy

Palani Velu, L.K., McKay, C.J., Carter, C.R., McMillan, D.C. , Jamieson, N.B. and Dickson, E.J. (2016) Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy. British Journal of Surgery, 103(5), pp. 553-563. (doi: 10.1002/bjs.10098) (PMID:26898605)

Abstract

Background: Pancreas-specific complications (PSCs), comprising postoperative pancreatic fistula, haemorrhage and intra-abdominal collections, are drivers of morbidity and mortality after pancreaticoduodenectomy (PD). A serum amylase concentration of 130 units/l or more on postoperative day (POD) 0 has been shown to be an objective surrogate of pancreatic texture, a determinant of PSCs. This study evaluated serial measurements of C-reactive protein (CRP) to refine PSC risk stratification. Methods: Consecutive patients undergoing PD between 2008 and 2014, with vascular resection if required and without preoperative chemoradiotherapy, had serum investigations from the day before operation until discharge. Receiver operating characteristic (ROC) curve analysis was used to identify a threshold value of serum CRP with clinically relevant PSCs for up to 30 days after discharge as outcome measure. Results: Of 230 patients, 95 (41·3 per cent) experienced a clinically relevant PSC. A serum CRP level of 180 mg/l or higher on POD 2 was associated with PSCs, prolonged critical care stay and relaparotomy (all P < 0·050). Patients with a serum amylase concentration of 130 units/l or more on POD 0 who developed a serum CRP level of at least 180 mg/l on POD 2 had a higher incidence of morbidity. Patients were stratified into high-, intermediate- and low-risk groups using these markers. The low-risk category was associated with a negative predictive value of 86·5 per cent for development of clinically relevant PSCs. There were no deaths among 52 patients in the low-risk group, but seven deaths among 79 (9 per cent) in the high-risk group. Conclusion: A serum amylase level below 130 units/l on POD 0 combined with a serum CRP level under 180 mg/l on POD 2 constitutes a low-risk profile following PD, and may help identify patients suitable for early discharge.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jamieson, Professor Nigel and McMillan, Professor Donald and Palani Velu, Dr Lavanniya and Carter, Mr Ross
• Authors: Palani Velu, L.K., McKay, C.J., Carter, C.R., McMillan, D.C., Jamieson, N.B., and Dickson, E.J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: British Journal of Surgery
• Journal Abbr.: Br J Surg
• Publisher: Wiley
• ISSN: 0007-1323
• ISSN (Online): 1365-2168
• Published Online: 22 February 2016
• Copyright Holders: Copyright © 2016 BJS Society Ltd
• First Published: First published in British Journal of Surgery 103(5):553-563
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher