Medicina v Kuzbasse (May 2023)
DIAGNOSTIC VALUE OF C REACTIVE PROTEIN AND PROCALCITONIN AS PROGNOSTIC MARKERS OF CLINICALLY RELEVANT PANCREATIC FISTULA AFTER PANCREATODUODENAL RESECTION
Abstract
The aim of the study – to evaluate the diagnostic value of C reactive protein (CRP) and procalcitonin (PCT) as prognostic markers of clinically relevant pancreatic fistula (CR PPF) after pancreatoduodenal resection (PDR) Methods and materials. A two-center retrospective-prospective study was carried out. The study included 122 patients – 56 women (47.9 %) and 61 men (52.1 %). All patients included in the study were operated on in the volume of pancreatoduodenal resection. The patients were divided into two groups: 1) patients, postoperative the period of which proceeded without the development of CR PPF – the control group and 2) patients in whom the postoperative period was complicated by the development of CR PPF. Determination of CRP and PCT was carried out on the 1st, 2, 3, 4th postoperative days (POD), the dynamics of CRP between different POD, the ratio of CRP to PCT, was also evaluated. In order to determine the diagnostic accuracy of the estimated parameters, an ROC analysis was performed to determine the area of the areas under curves (AUC), the optimal cut-off point, sensitivity, and specificity. Results. Сlinically relevant PPF were observed in 21 (17.9 %) cases. According to the results of the study, when conducting ROC analysis, it was found that the level of CRP was more than 201.4 mg/l, PCT was more than 1.87 ng/ml, the ratio of CRP to PCT was more than 124.7 on the 4th POD (AUC 0.872, 0.846, 0.917 respectively), as well as the difference in CRP values between the 1st and 4th POD of more than 80.4 mg/l (AUC 0.895) are diagnostic predictors of CRPPF after PDR Conclusion. The index of CRP, PCT and the ratio of CRP/PCT on the 4th POD, as well as the assessment of the difference in the value of CRP between the 1st and 4th POD are quite informative prognostic markers of the CR PPF after the PDR.
