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. 2022 Aug;407(5):1949-1959.
doi: 10.1007/s00423-022-02440-9. Epub 2022 Mar 20.

C-reactive protein identifies patients at risk of postpancreatectomy hemorrhage

C Vilhav  1 , J B Fagman  2 , E Holmberg  2 , P Naredi  2 , C Engström  2
Affiliations

C-reactive protein identifies patients at risk of postpancreatectomy hemorrhage

C Vilhav et al. Langenbecks Arch Surg. 2022 Aug.

Abstract

Background: Postpancreatectomy hemorrhage grade C (PPH C) is a dreaded complication after pancreaticoduodenectomy (PD) with high mortality rate. Concurrent risk factors for PPH C have been difficult to recognize. Connection between postoperative pancreatic fistulas (POPF) and PPH C is well known, but POPF is often unknown prior to the PPH. The aim of this retrospective study was to define potential predictive factors for PPH C.

Methods: Retrospectively, 517 patients who underwent PD between 2003 and 2018 were included in the study. Twenty-three patients with PPH C were identified, and a matched control group of 92 patients was randomly selected. Preoperative data (body mass index, cardiovascular disease, history of abdominal surgery, biliary stent, C-reactive protein (CRP), ASA-score), perioperative data (bleeding, pancreatic anastomosis, operation time), and postoperative data (CRP, drain amylase, POPF, biliary fistula) were analyzed as potential predictors of PPH C.

Results: High postoperative CRP (median 140 mg/L on day 5 or 6) correlated with the development of PPH C (p < 0.05). Postoperative drain amylase levels were not clinically relevant for occurrence of PPH C. Grade C POPF or biliary leak was observed in the majority of the PPH C patients, but the leaking anastomoses were not detected before the bleeding started.

Discussion: High postoperative CRP levels are related to an increased risk of PPH C.

Keywords: C-reactive protein; Pancreatic cancer; Pancreatic surgery; Pancreaticoduodenectomy; Postoperative pancreatic fistula; Postpancreatectomy hemorrhage.

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Conflict of interest statement

The authors declare no competing interests.

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